Introduction Acute severe ulcerative colitis (ASUC) remains a common reason for urgent colectomy, yet there are relatively few large cohort studies exploring prognosis and outcome.1–3 This study aims to examine presentation and management of ASUC in the Western General Hospital, a tertiary referral centre in Edinburgh and to identify prognostic factors.
Methods Patients were identified from a large database of participants in genetic studies in Edinburgh, as well as from two previous small cohorts of ASUC studied in Edinburgh. More recent cases were found from minutes of a weekly IBD meeting. Cases were included if they met the standard clinical, radiological and pathological criteria for ulcerative colitis and required an admission for 3 days or more requiring intravenous corticosteroids and/or colectomy. Two cohorts were analysed, one with full clinical detail (97 admissions in 86 patients) and one with more basic detail (444 admissions in 323 patients).
Results Overall colectomy rate was 31.8%. Haemoglobin, C reactive protein and albumin at days 0 and 3 were significant predictors of colectomy in both cohorts (p<0.05 in each case), while in the detailed cohort day 3 but not day 0 stool frequency was predictive (p<0.001 and 0.81 respectively). A simple score was derived to predict colectomy at admission based on disease extent, albumin and CRP. Scores of 0, 1, 2 and 3 corresponded to risks for colectomy of 10%, 31%, 61% and 75%. For day 3 parameters, both the Edinburgh acute colitis (Ho) score (Abstract PTU-123 figure 1) and Travis criteria performed well.
Conclusion ASUC remains an important cause of colectomy. This study confirms the prognostic value of the Ho score and Travis criteria at day 3, but also indicates that day 0 CRP and albumin are strong predictors of outcome.
Competing interests None declared.
References 1. Dinesen LC, et al. J Crohns Colitis 2010;4:431–7.
2. Ho GT, et al. Aliment Pharmacol Ther 2004;19:1079–87.
3. Turner D, et al. Clin Gastroenterol Hepatol 2007;5:103–10.
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