Severe Ulcerative Colitis: Parameters Determining Outcomes
Severe Ulcerative Colitis: Parameters Determining Outcomes
Background: One-third of patients with exacerbations of ulcerative colitis (UC) require colectomy and 1% die. Although several studies have reported parameters associated with failure of medical treatment, studies using multivariate analysis of various predictors are scanty.
Methods: Demographic, clinical and laboratory parameters within 48 h of admission of 50 consecutive patients (55 episodes) were prospectively recorded. Each episode was treated with intravenous hydrocortisone, antibiotics and fluid administration. The data of patients who failed to respond, deteriorated, developed complications requiring emergency surgery or died within 7 days of hospitalization, were compared with the data of those who responded during this period using Mann-Whitney U-test or chi-squared tests. Variables found to be significant on univariate analysis were entered into a multivariate model.
Results: Medical treatment failed in 10 of 55 episodes; eight had surgery (one died), another died with bowel perforation and peritonitis and one left hospital in a moribund state. Younger age, pedal edema, transverse colonic diameter >5 cm on abdominal radiograph, low hemoglobin, low serum albumin, high C-reactive protein, presence of fibrin degradation product (FDP) in serum, low serum fibrinogen, prolonged prothrombin time, Truelove-Witt's fulminant disease, and high clinical activity index were associated with failure of medical treatment on univariate analysis. All the above variables were significant by multivariate analysis except age, serum albumin level and presence of FDP.
Conclusion: It may be possible to predict the failure of medical treatment in exacerbations of UC using a scoring system based on clinical parameters and simple laboratory tests.
Despite recent advances in pharmacotherapy for ulcerative colitis (UC), relapses of varying severity occur in 12-58% of patients with this disease while on treatment. One-third of patients with a severe relapse of UC require colectomy during index hospitalization, and 1-3% have a fatal outcome. Timing of surgery in acute severe colitis is still based on the physician's subjective assessment rather than on objective criteria. The most popular scoring system for assessment of the severity of an attack of UC, as described by Truelove and Witts, has several limitations. These include: (i) limited discriminative ability due to classification of disease severity into only four groups; (ii) somewhat vague and subjective demarcation between groups; and (ii) inclusion of only a few parameters for severity assessment. Lichtiger et al., while studying the role of cyclosporine in patients with severe UC, described another scoring system named the clinical activity index (CAI). However, this system has not been validated subsequently. Some workers have evaluated a number of simple laboratory tests to prognosticate the outcome of patients with severe UC. However, most of these studies have assessed (i) only one or a few laboratory tests or (ii) a few clinical parameters in combination with one laboratory test. Therefore, we decided to evaluate various clinical and laboratory parameters and scoring systems comprehensively in determining the outcome of patients with severe UC, using univariate and multivariate analysis.
Background: One-third of patients with exacerbations of ulcerative colitis (UC) require colectomy and 1% die. Although several studies have reported parameters associated with failure of medical treatment, studies using multivariate analysis of various predictors are scanty.
Methods: Demographic, clinical and laboratory parameters within 48 h of admission of 50 consecutive patients (55 episodes) were prospectively recorded. Each episode was treated with intravenous hydrocortisone, antibiotics and fluid administration. The data of patients who failed to respond, deteriorated, developed complications requiring emergency surgery or died within 7 days of hospitalization, were compared with the data of those who responded during this period using Mann-Whitney U-test or chi-squared tests. Variables found to be significant on univariate analysis were entered into a multivariate model.
Results: Medical treatment failed in 10 of 55 episodes; eight had surgery (one died), another died with bowel perforation and peritonitis and one left hospital in a moribund state. Younger age, pedal edema, transverse colonic diameter >5 cm on abdominal radiograph, low hemoglobin, low serum albumin, high C-reactive protein, presence of fibrin degradation product (FDP) in serum, low serum fibrinogen, prolonged prothrombin time, Truelove-Witt's fulminant disease, and high clinical activity index were associated with failure of medical treatment on univariate analysis. All the above variables were significant by multivariate analysis except age, serum albumin level and presence of FDP.
Conclusion: It may be possible to predict the failure of medical treatment in exacerbations of UC using a scoring system based on clinical parameters and simple laboratory tests.
Despite recent advances in pharmacotherapy for ulcerative colitis (UC), relapses of varying severity occur in 12-58% of patients with this disease while on treatment. One-third of patients with a severe relapse of UC require colectomy during index hospitalization, and 1-3% have a fatal outcome. Timing of surgery in acute severe colitis is still based on the physician's subjective assessment rather than on objective criteria. The most popular scoring system for assessment of the severity of an attack of UC, as described by Truelove and Witts, has several limitations. These include: (i) limited discriminative ability due to classification of disease severity into only four groups; (ii) somewhat vague and subjective demarcation between groups; and (ii) inclusion of only a few parameters for severity assessment. Lichtiger et al., while studying the role of cyclosporine in patients with severe UC, described another scoring system named the clinical activity index (CAI). However, this system has not been validated subsequently. Some workers have evaluated a number of simple laboratory tests to prognosticate the outcome of patients with severe UC. However, most of these studies have assessed (i) only one or a few laboratory tests or (ii) a few clinical parameters in combination with one laboratory test. Therefore, we decided to evaluate various clinical and laboratory parameters and scoring systems comprehensively in determining the outcome of patients with severe UC, using univariate and multivariate analysis.
Source...