Results of multicenter observational study «predictors of colectomy in patients with extremely severe ulcerative colitis

AIM: to improve the results of treatment of patients with «extremely severe» ulcerative colitis (UC).

PATIENTS AND METHODS: A multicenter observational prospective «case-control» study was conducted. The study included 71 patients with «extremely» severe UC from June 2019 to October 2021. All patients underwent conservative therapy in accordance with current clinical guidelines. Evaluation of the effectiveness of treatment was carried out on the 3rd and 7th days of therapy, a "response" or "no response" to steroid therapy was stated.

RESULTS: A total of 48 (68%) patients underwent surgical treatment during the follow-up period during hospitalization. 23 (32%) patients "responded" to conservative therapy and were discharged without colectomy. A reliable independent predictor of colectomy at the time of hospitalization was the level of albumin less than 29 g/l (OR – 8,6 95% CI: 2,5 – 39,9, p=0,002). On day 3, the reliable predictors were the level of C-reactive protein over 15.5 mg/l (OR – 9 95% CI: 2.4 – 46.1, p=0.003) and the value of the Mayo index above 7 points (OR – 13.3 95% CI: 3.3 – 75.7, p=0.0009).

CONCLUSION: The study has demonstrated that the only reliable and independent predictor of colectomy at admission to the clinic is the level of albumin less than 29 g/l. Reliable factors that make it possible to evaluate and predict the effectiveness of therapy are the level of C-reactive protein more than 15.5 mg/l and the value of the Mayo index above 7 points on the 3rd day of therapy, as well as the level of C-reactive protein above 29 mg/l on the 7th day.

1. Zhao M, Gonczi L, et al. The Burden of Inflammatory Bowel Disease in Europe in 2020. Journal of Crohn’s and colitis. 2021;15(9):1573– 1587.doi: 10.1093/ecco-jcc/jjab029

2. Burisch J, Vardi H, et al. Epi-IBD group. Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study. The Lancet Gastroenterology & Hepatology. 2020;5(5):454– 464. doi: 10.1016/S2468-1253(20)30012-1

3. Leeds I, Sundel M, et al. Outcomes for ulcerative colitis with delayed emergency colectomy are worse when controlling for preoperative risk factors. Dis Colon Rectum. 2019;62(5):600–607. doi: 10.1097/DCR.0000000000001276

4. Nguen G, Du L, et al. Hypoalbuminaemia and Postoperative Outcomes in Inflammatory Bowel Disease: the NSQIP Surgical Cohort. Journal of Crohn’s and Colitis. 2019;1433–1438. doi: 10.1093/eccojcc/jjz083

5. Ordas I, Domenech E, et al. Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry. The American journal of Gastroenterology. 2018;113(7):1009–1016. doi: 10.1038/s41395-018-0057-0

6. Ivashkin V.T., Shelygin Yu.A., Belousova E.A., et al. Project clinical guidelines for the diagnostics and treatment of ulcerative colitis. Koloproktologia. 2019;4:7–36. (in Russ.). doi: 10.33878/2073-7556-2019-18-4-7-36

7. Achkasov S.I., Shapina M.V., Vardanyan A.V., et al. Predictors of colectomy in patients with «extremely severe» ulcerative colitis. Koloproktologia. 2020;19(3):37–48. (in Russ.). doi: 10.33878/2073-7556-2020-19-3-37-48

8. Eronen H, Ilus T, et al. Long-term outcome of patients with acute ulcerative colitis after first course of intravenous corticosteroids. Scandinavian journal of gastroenterology. 2021;56(3):234–238. doi: 10.1080/00365521.2020.1867892

9. Grant RK, Jones GR, et al. The ACE (Albumin, CRP and Endoscopy) Index in Acute Colitis: A Simple Clinical Index on Admission that Predicts Outcome in Patients With Acute Ulcerative Colitis. Inflammatory bowel disease. 2021;27(4):451–457. doi: 10.1093/ibd/izaa088

10. Patrick D, Doecke JD, et al. Short-term colectomy is avoided in over half of regional patients failing medical therapy for acute severe ulcerative colitis with co-ordinated transfer and tertiary care. Internal medicine journal. 2020;50(7):823–829. doi: 10.1111/imj.14649

11. Tanaka M, Takagi T, et al. Low serum albumin at admission is a predictor of early colectomy in patients with moderate to severe ulcerative colitis. JGH Open. 2021;5:377–381. doi: 10.1002/jgh3.12506

12. Kevans D, Murthy S, Mould DR, et al. Accelerated Clearance of Infliximab is Associated With Treatment Failure in Patients With Corticosteroid-Refractory Acute Ulcerative Colitis. Journal of Crohn’s and colitis. 2018;12:662–669. doi: 10.1093/ecco-jcc/jjy028

13. Croft A, Lord A, et al. Markers of Systemic Inflammation in Acute Attacks of Ulcerative Colitis: What Level of C-reactive protein Constitutes Severe Colitis? Journal of Crohn’s and colitis. 2022;jjac014. doi: 10.1093/ecco-jcc/jjac014