Outcomes of patients admitted with acute, severe ulcerative colitis on biologic therapy: a retrospective analysis from a tertiary referral hospital

• Published in: Journal of the Canadian Association of Gastroenterology Vol. 7; no. 4; pp. 306 - 311
• Main Authors: Sabrie, Nasruddin, Jogendran, Manisha, Jogendran, Rohit, Targownik, Laura E
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.08.2024
• Subjects: Original; readmission; ulcerative colitis; biologic therapy
• ISSN: 2515-2084; 2515-2092; 2515-2092
• DOI: 10.1093/jcag/gwae017

Abstract Background In steroid-refractory acute, severe, ulcerative colitis (ASUC), salvage medical therapy with infliximab is recommended to reduce the risk of colectomy. However, the evidence supporting this practice is based on cohorts naïve to biologics. Consequently, the management of patients on biologic or small molecule therapy (BST) with ASUC is not well defined. Methods We conducted a retrospective chart review of patients admitted with ASUC to Mount Sinai Hospital (MSH) in Toronto, Ontario from January 2018 until January 2022. Included subjects were considered to be on BST if they had received a dose of these agents within 56 days prior to admission. Our outcomes of interest included the mean difference in hospital length of stay (HLOS), rates of surgical consultation, rates of inpatient colectomies, and 90-day readmission rates between the 2 groups. Results Of the 185 admissions for ASUC, 76 were on BST prior to admission and 109 were not. Baseline characteristics were similar between the 2 groups. There were no significant differences in hospital length of stay (7.46 days vs 7.45 days P = .52) or in-hospital colectomy rates between the 2 groups. Patients on BST had higher rates of surgical consultation (36.8% vs 8.3% P < .01) and 90-day readmission rates (26.3% vs 13.8% P = .03). Conclusions We did not identify significant differences in the majority of our outcomes between the 2 groups. However, patients on BST were more likely to receive a surgical consultation during their admission and had higher rates of readmission at 90 days. Further studies evaluating the underlying factors that contribute to readmission in patients on BST in hospitals are needed. Lay Summary Ulcerative colitis (UC) causes inflammation of the large colon. Many patients with UC are treated with medications called biologics. We wanted to know if being on biologics affects how patients with UC do in the hospital during a severe flare. We compared patients already on biologics to those not on them. We did not find a big difference in how they did. However, patients on biologics were more likely to be seen by a surgeon in the hospital and return to the hospital within 90 days.