P0276 As severe as Acute Severe Ulcerative Colitis (ASUC)? Clinical findings from a large cohort of moderately severe acute Ulcerative Colitis inpatients

Le résumé fourni par la source

Abstract Background The Truelove and Witts criteria (TWC) has historically guided clinical decision-making for the disposition of acute Ulcerative Colitis (UC) patients.1 However, many TWC moderately severe (MSUC) patients also require inpatient management for intravenous corticosteroids (IVCS). We aimed to explore the clinical characteristics of this inpatient MSUC cohort, characterise disease severity on admission and evaluate inpatient treatment type and response, including risk of colectomy. Methods We retrospectively identified patients admitted to a single tertiary referral centre for inpatient medical therapy who did not meet TWC for ASUC. MSUC cases were separated into three groups based on components of the TWC. Baseline admission characteristics, inpatient therapy and clinical outcomes were compared between patients with stool frequency (SF) <6 (± any additional TWC) versus SF ≥ 6 (in the absence of additional TWC). Propensity Score Matching (PSM) was performed with ASUC and MSUC (SF ≥ 6 without additional criteria) cohorts matched for gender, disease extent, Mayo Endoscopic Score (MES) and treatment on admission (advanced therapy, oral corticosteroids). Results 563 patients were admitted for acute UC between 2015 - 2025, of which 145 (29%) did not meet TWC for ASUC. Patients did not meet TWC due to 1) SF < 6 with ≥1 additional TWC (n = 27), 2) SF < 6 without additional TWC (n = 6), or 3) SF ≥ 6 without additional TWC (n = 112). The rate of IVHC response in the MSUC cohort was 40%. Thirteen colectomies occurred in patients with MSUC, predominantly in those with SF ≥ 6 (n = 12) versus SF < 6 (n = 1). 11% of MSUC inpatients underwent colectomy within 1-year, compared to 17% of TWC-positive ASUC inpatients (p = 0.169, Table 1). In patients with SF ≥ 6, applying a CRP threshold of ≥ 12mg/L compared to > 30mg/L would re-classify 38 patients (26%) as meeting ASUC criteria,2 including 6 patients that underwent colectomy for medically refractory disease. After PSM and adjustment for gender, disease extent, MES and treatment on admission, there was no significant difference in risk of colectomy at 30-days (ASUC 9% vs MSUC 5%, p = 0.367) or 90-days (ASUC 11% vs MSUC 5%, p = 0.158). This was maintained up to 1-year (ASUC 18% vs MSUC 13%, p = 0.479) and until last follow-up (Figure 1). Conclusion Overreliance on TWC may underestimate disease severity, colectomy risk and delay admission in patients with severe UC that require inpatient therapy. Patients presenting with a stool frequency of < 6 per 24 hours are likely to represent a less severe phenotype of acute UC. Reduction of the TWC CRP threshold to ≥ 12 mg/L would increase case capture of severe disease by 10%. Short-to-medium term colectomy risk was not significantly different between TWC ASUC and MSUC following PSM. References: 1. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041-8. 2. Croft A, Lord A, Radford-Smith G. Markers of Systemic Inflammation in Acute Attacks of Ulcerative Colitis: What Level of C-reactive Protein Constitutes Severe Colitis? J Crohns Colitis. 2022;16(7):1089-96. Conflict of interest: Dr. Etchegaray, Amirah: No conflict of interest Goetz, Naeman: No conflict of interest Hannigan, Katherine: No conflict of interest Phillips, Jennifer: No conflict of interest Kumar, Rina: No conflict of interest Tambakis, George: No conflict of interest Radford-Smith, Graham: No conflict of interest Walker, Gareth: In the last 24 months, Dr Walker has received investigator grants or served as a speaker, a consultant or an advisory board member for: Janssen AbbVie Takeda Ferring Dr Falk Pharma Georgiamune Croft, Anthony: No conflict of interest

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.