CT-Visualized Colonic Mural Stratification Independently Predicts the Need for Medical or Surgical Rescue Therapy in Hospitalized Ulcerative Colitis Patients

• Published in: Digestive diseases and sciences Vol. 64; no. 8; pp. 2265 - 2272
• Main Authors: Cushing, Kelly C., Kordbacheh, Hamed, Gee, Michael S., Kambadakone, Avinash, Ananthakrishnan, Ashwin N.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2019; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Biochemistry; Colectomy; Colitis, Ulcerative - diagnostic imaging; Colitis, Ulcerative - therapy; Colon; Colon - diagnostic imaging; CT imaging; Drug Resistance; Drug Substitution; Female; Gastroenterology; Hepatology; Hospitalization; Humans; Immunosuppressive Agents - therapeutic use; Inflammatory bowel disease; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Multidetector Computed Tomography; Oncology; Original Article; Predictive Value of Tests; Prognosis; Reproducibility of Results; Retrospective Studies; Risk Factors; Salvage Therapy; Steroids - therapeutic use; Transplant Surgery; Treatment Failure; Tumor Necrosis Factor Inhibitors - therapeutic use; Ulcerative colitis; Young Adult; Rescue therapy; Mural stratification; Ulcerative colitis
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05520-x

Background Severe ulcerative colitis is associated with significant morbidity. Multidetector computed tomography (MDCT) scans are frequently obtained upon hospital admission, but the ability of radiographic findings to predict steroid failure is unknown. Aim To identify MDCT features predictive of inpatient rescue in hospitalized UC. Methods Patients hospitalized with UC who underwent a CT scan within 48 h of hospitalization were retrospectively identified. Radiologists blinded to the outcome prospectively evaluated CT scans for the presence of bowel wall thickening, stranding, and hyperenhancement as well as mural stratification, mesenteric hyperemia, and proximal dilation. Logistic regression adjusting for potential confounders was used to test the independent association between radiographic findings and need for rescue therapy. Results The study cohort included 74 patients. The mean age of the group was 45 years, and two-thirds (66%) were male. Twenty-eight (38%) patients required either inpatient medical rescue or colectomy. The mean number of positive radiographic findings was 4.4 (range 2–6) with a higher median number of findings in those who required rescue therapy (5 vs. 4, p  = 0.03). Mural stratification was significantly more common among those who required rescue therapy (92% vs. 49%, p  = 0.001). No other radiographic findings were independently associated with inpatient rescue. On multivariable analysis, mural stratification (OR 14.9, 95% CI 2.76–80.2) and number of positive findings (OR 2.10, 95% CI 1.06–4.16) remained independently predictive of the need for rescue therapy. Conclusions Mural stratification was highly predictive of steroid refractoriness and need for medical or surgical rescue therapy in hospitalized UC.