dc.contributor.author | Subhaharan, D | |
dc.contributor.author | Ramaswamy, P Kakkadasam | |
dc.contributor.author | Moattar, H | |
dc.contributor.author | Shukla, D | |
dc.contributor.author | Ishaq, N | |
dc.contributor.author | Bhullar, M | |
dc.contributor.author | Dorrington, A | |
dc.contributor.author | Sawyer, E | |
dc.contributor.author | James, R | |
dc.contributor.author | McLean, R | |
dc.contributor.author | Oriss, R | |
dc.contributor.author | Lyons, T | |
dc.contributor.author | Edwards, J | |
dc.contributor.author | Mohsen, W | |
dc.date.accessioned | 2021-02-26T01:05:30Z | |
dc.date.available | 2021-02-26T01:05:30Z | |
dc.date.issued | 2020 | |
dc.identifier.issn | 0815-9319 | |
dc.identifier.uri | http://hdl.handle.net/10072/402632 | |
dc.description.abstract | Background and Aim: Medical rescue therapy is effective in the treatment of patients with corticosteroid‐refractory acute severe ulcerative colitis (ASUC), and studies have shown that the efficacy of infliximab and cyclosporin A is similar. We aimed to identify predictors of colectomy in this population of patients who received medical rescue therapy.
Methods: We included all admissions for ASUC (fulfilling Truelove and Witts criteria) between January 1, 2015, and April 30, 2020, at an Australian tertiary referral center. Electronic medical records were reviewed, and clinical, endoscopic, and laboratory data were collected. Patients who received medical rescue therapy after failing intravenous corticosteroid therapy were identified. We performed logistic regression analysis to identify predictors of colectomy during the same admission.
Results: A total of 128 patients were included. Of these, 51 patients (39.8%) received medical rescue therapy (four cyclosporin, 47 infliximab [32 received 5 mg/kg, 15 received 10 mg/kg]) (Table 1). Among patients who received rescue therapy, the colectomy rate was 17.6% (9/51) during the same admission and 21.5% (11/51) within 12 months. On univariate analysis, the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score at admission (odds ratio [OR], 2.53, 95% confidence interval, 1.19–5.38; P = 0.016) and C‐reactive protein (CRP) level on Day 3 after rescue therapy (OR, 1.03; 95% confidence interval, 1.006–1.05; P = 0.011) were predictors of the need for colectomy during the same admission. We developed a score allocating one point each to UCEIS on admission ≥ 7 and CRP level on Day 3 after rescue therapy ≥ 22 mg/L. A score of 2 had a sensitivity of 57% and specificity of 100% (positive predictive value [PPV], 100%; negative predictive value, 91.2%) for predicting colectomy during the same admission (area under the receiver operating characteristic curve, 0.931; P < 0.001) (Table 2).
Conclusion: Admission UCEIS score and Day 3 after medical rescue CRP level are predictors of failure of medical rescue therapy in patients with ASUC. The combination of admission UCEIS ≥ 7 and Day 3 after medical rescue CRP level ≥ 22 mg/L had a 100% PPV for colectomy during the same admission. | |
dc.language | English | |
dc.publisher | Wiley | |
dc.publisher.uri | https://onlinelibrary.wiley.com/doi/10.1111/jgh.15271 | |
dc.relation.ispartofconferencename | Australian Gastroenterology Week (AGW) 2020 | |
dc.relation.ispartofconferencetitle | Journal of Gastroenterology and Hepatology | |
dc.relation.ispartofdatefrom | 2020-11-21 | |
dc.relation.ispartofdateto | 2020-11-30 | |
dc.relation.ispartofpagefrom | 154 | |
dc.relation.ispartofpageto | 155 | |
dc.relation.ispartofissue | S1 | |
dc.relation.ispartofvolume | 35 | |
dc.subject.fieldofresearch | Clinical sciences | |
dc.subject.fieldofresearchcode | 3202 | |
dc.subject.keywords | Science & Technology | |
dc.subject.keywords | Life Sciences & Biomedicine | |
dc.subject.keywords | Gastroenterology & Hepatology | |
dc.title | Endoscopic severity and C-reactive protein level predict failure of medical rescue therapy in patients with acute severe ulcerative colitis | |
dc.type | Conference output | |
dc.type.description | E3 - Conferences (Extract Paper) | |
dcterms.bibliographicCitation | Subhaharan, D; Ramaswamy, PK; Moattar, H; Shukla, D; Ishaq, N; Bhullar, M; Dorrington, A; Sawyer, E; James, R; McLean, R; Oriss, R; Lyons, T; Edwards, J; Mohsen, W, Endoscopic severity and C-reactive protein level predict failure of medical rescue therapy in patients with acute severe ulcerative colitis, Journal of Gastroenterology and Hepatology, 2020, 35, pp. 154-155 | |
dc.date.updated | 2021-02-26T01:03:00Z | |
gro.hasfulltext | No Full Text | |
gro.griffith.author | Subhaharan, Deloshaan | |