Predictive factors of outcome of intensive intravenous treatment for attacks of ulcerative colitis

Abstract

Background: Intensive intravenous treatment remains the first line therapy of severe, uncomplicated attacks of ulcerative colitis. Aim: To predict the failure of intensive intravenous treatment by combining clinical and laboratory parameters with endoscopy findings. Methods: Retrospective study conducted in a tertiary care referral centre. Failure of intensive intravenous treatment was defined as colectomy before day 30, intravenous cyclosporin, or death. Predictive factors of outcome were assessed using univariate and multivariate prognostic analysis. Results: Between January 1990 and May 1997, 85 consecutive patients were treated with intensive intravenous treatment for non‐response to oral corticosteroids (n=59) and/or severe attack of ulcerative colitis (n=26). There were 41 successes and 44 failures (including 1 death, 13 cyclosporin and 30 colectomies before day 30). Multivariate prognostic analysis found that the presence of Truelove and Witts’ criteria (P=0.018), an attack that had lasted more than 6 weeks (P=0.001), and severe endoscopic lesions (P=0.007) were associated with an increased risk of failure. Patients with severe endoscopic lesions and Truelove and Witts’ criteria, or an attack of more than 6 weeks had a failure rate of 85–86%. Conclusion: Clinical, laboratory and endoscopic findings can predict the risk of failure of intensive intravenous treatment. A prospective study is required to confirm these results.

Prognostic factors for colectomy in refractory ulcerative colitis treated with calcineurin inhibitors

“…In this study, the disease extent (10-13), disease duration (14,15), gender (16,17) and endoscopic findings (14,15,18,19) were not significant predictive factors for a colectomy as well as CNI non-responsiveness, although previous reports have identified these factors to predict the outcome. Most of these previous reports investigated the prognostic factors of patients treated with corticosteroids.…”

Infliximab three-dose induction regimen in severe corticosteroid-refractory ulcerative colitis: Early and late outcome and predictors of colectomy

“…23 The severity of endoscopic lesions, particularly the presence of deep or large ulcers, has been associated with the risk colectomy in several studies. 21,[29][30][31] However, in the only randomised, placebo-controlled study by Jarnerot et al 8 the severity of endoscopic lesions predicted response to neither IFX, nor colectomy. In our study, the presence of severe endoscopic lesions, defined as the presence of deep ulcerations and/or spontaneous bleeding, was independently associated with the overall risk of colectomy and with the risk of long-term colectomy in patients escaping early colectomy.…”

Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases

“…Thus, a high stool number, the persistence of high levels of CRP, the persistence of rectal bleeding after three days of intravenous corticosteroids have become simple criteria for the introduction of rescue therapies such as ciclosporin or Infliximab. Using similar criteria for clinical response, two prospective studies [4] [6] and two retrospective studies [5] [7] reported an initial efficacy of intravenous corticosteroids of 40% -57%. In the long-term follow-up of patients with severe acute colitis, Bojic et al reported that patients who had a partial response after 7 days of intravenous corticosteroid had a significantly higher cumulative probability of colectomy in follow-up than those who achieved early clinical remission [8].…”