Predicting the Course of Disease in Hospitalized Patients With Acute Severe Ulcerative Colitis

Bernardo, Sónia; Gonçalves, Ana; Valente, A; Baldaia, Cilénia; Santos, Paula Moura; Correia, Luís

doi:10.1093/ibd/izy256

Cited by 13 publications

(11 citation statements)

References 20 publications

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“…Overall, 26% required rescue therapy, and 12% required bowel resection within 30 days of admission, in keeping with modern acute severe UC series. 34,35 When patients were analyzed strictly within North Shore hospital, signals from data comparing patients treated with IVHC from June 2016 to June 2018 to patients treated with IVMP from January 2018 to January 2019 remain the same. This includes requirement for rescue therapy IVMP versus IVHC OR = 2.57, P = 0.01 and hypokalemia OR = 0.39, P = 0.004 (Table S1).…”

Section: Discussionmentioning

confidence: 99%

A comparison of intravenous methylprednisolone and hydrocortisone for the treatment of acute inflammatory bowel disease

Schauer

Avery

Seleq

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Despite widespread recommendations and use of intravenous corticosteroids (IVCS) for the treatment of acute flares of ulcerative colitis and Crohn's disease, limited evidence exists comparing outcomes of the two most common regimens, intravenous methylprednisolone (IVMP) and intravenous hydrocortisone (IVHC). IVHC has stronger mineralocorticoid effects compared with IVMP and may cause higher rates of hypokalemia. We aimed to determine differences in clinical outcomes including requirement for inpatient rescue therapy, bowel resection, and rates of hypokalemia. Methods: We conducted a multicenter cohort study of all adult patients admitted with an acute flare of inflammatory bowel disease (IBD) to the three tertiary hospitals in Auckland, New Zealand, where the protocol at each institution is either IVMP 60 mg daily or IVHC 100 mg four times daily. All patients requiring IVCS between 20 June 2016 and 30 June 2018 were included. The IVCS protocol was then changed at one hospital, where further data were collected for a further 12 months from 30 January 2019 until 30 December 2019. Results: There were 359 patients, including 129 (35.9%) patients receiving IVMP and 230 (64.1%) patients receiving IVHC. IVMP treatment was associated with a greater requirement for rescue therapy than IVHC (36.4% vs 19.6%, P = 0.001; odds ratio [OR] = 2.79; 95% confidence interval [CI], 1.64-4.75, P < 0.001), but also reduced rates of hypokalemia (55.8% vs 67.0%, P = 0.04; OR = 0.49; 95% CI, 0.30-0.81, P = 0.005). There was no difference between treatment groups for the median length of admission (5 days, interquartile range [IQR] 3-8), median duration of IVCS treatment (3 days, IQR 2-5), or bowel resection within 30 days of admission (12.4% vs 11.7%; OR = 1.04). Conclusion:For the treatment of an acute flare of IBD, treatment with IVMP results in significantly more requirement for inpatient rescue biologic or cyclosporin. In addition, it causes statistically significant less hypokalemia than IVHC, although in practice differences are negligible.

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Section: Discussionmentioning

confidence: 99%

A comparison of intravenous methylprednisolone and hydrocortisone for the treatment of acute inflammatory bowel disease

Schauer

Avery

Seleq

et al. 2021

J of Gastro and Hepatol

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“…The ability to accurately predict response to infliximab salvage and the subsequent risk of colectomy is crucial in order to decide the most appropriate maintenance therapy, which is an important concept in modern precision medicine. 12,13 Moreover, the optimal timing and dosing regimen of infliximab salvage is subject to ongoing research, 14 therefore a predictive score for infliximab failure early in the presentation might facilitate timely decisions for potential dose escalation, additional line medical salvage, or early colectomy. 15,16 Biomarkers are increasingly recognized to play a crucial role in precision medicine, and useful biomarkers to aid in clinical prediction are needed.…”

Section: Introductionmentioning

confidence: 99%

Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy

et al. 2022

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cerative colitis (ASUC) is a severe exacerbation of UC that warrants intravenous corticosteroids and may require emergency colectomy. 3 Corticosteroid failure necessitates salvage therapy with infliximab or ciclosporin which have demonstrated good short term efficacy. [4][5][6][7] However longer term prognosis after medical salvage remains guarded, where up to 50% of patients still proceed to colectomy in the absence of maintenance biologic therapy. [8][9][10] Conversely, a proportion of patients may have an initial period of significant symptoms, but develop only mild symptoms or even remission in the subsequent 10 years of

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“…The observed relationship between endoscopic severity and the failure of medical therapy has been well described elsewhere. 6,57,63 Whilst the UCEIS score has been found to have a better receiver operating characteristic (ROC) score for predicting the need for colectomy-by-discharge, the MES remains in widespread usage. 64 There is a balance to be struck between accessibility and the performance characteristics of the endoscopic scoring system.…”

Section: Discussionmentioning

confidence: 99%

“…A recent comparison of the accuracy of established risk scores (MES, Oxford, Edinburgh, Swedish) did analyse clinical outcomes including intravenous corticosteroid failure, rescue therapy administration and colectomy-by-discharge. 57 For all clinical endpoints the Swedish score had the highest AUC. In this Portuguese study of 112 TWC qualifying severe UC patients, corticosteroid treatment failure was defined by a clinical as opposed to a criteria-led decision for escalation to rescue medical therapy or surgery.…”

Section: Assessing Response To Corticosteroid Therapymentioning

confidence: 95%

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Risk assessment in acute ulcerative colitis

Croft¹

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An episode of acute severe ulcerative colitis (UC) represents an important watershed moment during the course of the disease with a heightened risk of colectomy during and following these episodes. As such, the prompt identification and early implementation of the appropriate treatment is paramount to obtaining the best clinical outcomes for these unwell patients.A prospective database of 349 consecutive presentations of Truelove and Witts criteria qualifying moderate and severe UC was collated at a single referral centre.This resource was interrogated to identify the C-reactive protein (CRP) level that corresponds with the erythrocyte sedimentation rate (ESR) that is widely accepted as a marker of severe disease activity. A CRP threshold of ≥12mg/L was found to be an inclusive and sensitive cut off that when incorporated into the Truelove and Witts criteria, replacing the traditional ESR >30mm/h criterion, had similar performance characteristics when applied to the assessment of UC disease activity.On the level of the individual patient, the serial CRP concentration is one of the few informative and objective measures of disease acuity and treatment response that will alter management during the hospital admission. This study provides the previously lacking reassurance that baseline immunomodulator usage status need not be taken into account when interpreting the ESR or CRP levels on presentation in established UC patients not on biologic therapy. As many published IBD severity and prognostic indices in contemporary use incorporate either the ESR or CRP as objective markers of disease acuity, this study has high translatability to patients with a secure diagnosis of UC not in their initial flare.Seventeen clinical, laboratory and endoscopic variables present at the time of hospital presentation were assessed for their ability to differentiate intravenous corticosteroid therapy responders from non-responders.A risk score based on a logistic model including the admission indices of oral corticosteroid failure, bowel frequency, CRP, albumin and either disease duration or Mayo endoscopic 3 subscore (MES) was trained on a set of 349 presentations of acute UC. This individualised risk score has the potential to inform clinicians as to the timing of treatment escalation in acute UC. 4

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Predicting the Course of Disease in Hospitalized Patients With Acute Severe Ulcerative Colitis

Abstract: In our series, the Lindgren score was superior to the Mayo, Oxford, and Edinburgh scores in predicting major clinical outcomes in ASUC.

Cited by 13 publications

References 20 publications

A comparison of intravenous methylprednisolone and hydrocortisone for the treatment of acute inflammatory bowel disease

A comparison of intravenous methylprednisolone and hydrocortisone for the treatment of acute inflammatory bowel disease

Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy

Risk assessment in acute ulcerative colitis

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