Predicting the Course of Disease in Hospitalized Patients With Acute Severe Ulcerative Colitis
Abstract Background Up to one-third of patients with acute severe ulcerative colitis (ASUC) will fail intravenous steroid (IVS) treatment, requiring rescue therapy with cyclosporin (Cys), infliximab (IFX), or colectomy. Although several scores for predicting response to IVS exist, formal comparison...
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Published in | Inflammatory bowel diseases Vol. 25; no. 3; pp. 541 - 546 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
US
Oxford University Press
21.02.2019
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Subjects | |
Online Access | Get full text |
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Summary: | Abstract
Background
Up to one-third of patients with acute severe ulcerative colitis (ASUC) will fail intravenous steroid (IVS) treatment, requiring rescue therapy with cyclosporin (Cys), infliximab (IFX), or colectomy. Although several scores for predicting response to IVS exist, formal comparison is lacking.
Methods
We performed a single-center retrospective analysis including 489 patients with ulcerative colitis. In patients with ASUC, the Mayo endoscopic subscore and the Oxford, Edinburgh, and Lindgren scores were assessed. Outcomes included IVS failure, need for rescue medical therapy, and surgery.
Results
One hundred twelve patients presented with ASUC. Forty-two percent showed an incomplete or absent response to IVS, 28.6% received rescue therapy (22 with IFX, 10 with Cys, and 1 with sequential treatment), and 26.8% required surgery. The Lindgren score showed the highest performance in predicting IVS failure (are under the curve [AUC], 0.856; 95% confidence interval [CI], 0.784–0.928), need for medical rescue therapy (AUC, 0.826; 95% CI, 0.749–0.902), and surgery (AUC, 0.836; 95% CI, 0.712–0.960; all P < 0.01).
Conclusions
In our series, the Lindgren score was superior to the Mayo, Oxford, and Edinburgh scores in predicting major clinical outcomes in ASUC. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 |
ISSN: | 1078-0998 1536-4844 |
DOI: | 10.1093/ibd/izy256 |