QS201 - Trends in Disease Severity and Rate of Colectomy After Inpatient Treatment for Acute Severe Ulcerative Colitis: 2013-2023

Purpose/Background: Improvements in advanced therapies and quality of healthcare might be associated with greater ability to rescue patients with Acute Severe Ulcerative Colitis (ASUC). We estimated changes in the rate of total abdominal colectomy (TAC) after hospitalization for ASUC over the last 10 years.

Methods/Interventions: We retrospectively reviewed the charts of consecutive ASUC patients needing inpatient treatment. Trends over 10 years for the rate of TAC at 3 and 12 months after inpatient treatment were estimated for patients treated with IV steroids alone, IV steroids and rescue-dose infliximab, or IV steroids and rescue-dose cyclosporine. Disease severity was assessed by CRP and calprotectin. Linear regression and Theil–Sen regression with Somers’ D statistic were computed to estimate time trends for colectomy within 3 months and 12 months of hospitalization.

Results/Outcomes: Between 2013 and 2023, there were 225 patients hospitalized for ASUC (median age 35 years, IQR 27.3-48; female gender 56%). Patients were treated with IV steroids (122, 54%), IV steroids and rescue-dose infliximab (98, 44%), or IV steroids and rescue-dose cyclosporin (5, 2%). The rate of colectomy at 3 months was 23.6%, 21.4%, and 80% among those treated with IV steroids, rescue-dose infliximab, and rescue-dose cyclosporine (p=0.022). The rate of colectomy at 12 months was 33.3%, 26.7%, and 100%, respectively (p=0.004). Across the decade, there was no change in the rate of undergoing colectomy within 3 months (Somers’ D 0.04; 95% CI -0.03 - 0.12; p=0.276) or 12 months (Somers’ D 0.04; 95% CI -0.04 - 0.13; p=0.39) of hospitalization. These trends were equivalent among patients treated with IV steroids and rescue dose Infliximab (p>0.05, Figure 1). Although the rates of colectomy did not change significantly over the decade, there was an uptrend of CRP levels (Somers’ D 0.34; 95% CI 0.25 - 0.42, p< 0.0005) and calprotectin levels upon admission (Somers’ D 0.15; 95% CI 0.03 - 0.28, p=0.018): every year, CRP increased on average by 6.73 mg/dL (95% CI 4.37 - 9.32), and calprotectin increased by 22.60 mcg/g (95% CI 0 - 110).

Conclusion/Discussion: Over the past decade, there appeared to be an increase in disease severity of ASUC patients requiring inpatient treatment. However, there appeared to be no significant change in the need for colectomy at 3 months and 12 months after inpatient treatment.