scholarly journals P333 Endoscopic severity and CRP predict failure of medical rescue therapy in patients with acute severe ulcerative colitis

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S357-S357
Author(s):  
P Kakkadasam Ramaswamy ◽  
D Subhaharan ◽  
L Willmann ◽  
J Edwards ◽  
D Shukla ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cyclosporin A ◽  
Corticosteroid Therapy ◽  
Disease Duration ◽  
Rescue Therapy ◽  
Multivariable Analysis ◽  
Severe Ulcerative Colitis ◽  
Intravenous Corticosteroid

Abstract Background The efficacy of Infliximab and Cyclosporin A as medical rescue therapy in patients with corticosteroid refractory acute severe ulcerative colitis (ASUC) is well established. We aimed to identify predictors of failure of medical rescue therapy and colectomy during the same admission in this population. Methods Patients hospitalized with ASUC who received infliximab or cyclosporin A after failing intravenous corticosteroid therapy between 1st January 2013 to 31stJuly, 2020 at two Australian tertiary IBD centres were retrospectively analysed. Patients who underwent colectomy during the same admission after medical rescue therapy were defined as non-responders. Logistic regression analysis was performed to identify predictors of colectomy during same admission. Results 226 episodes of ASUC [110 (48.7%) female, median disease duration 2 years] were analysed. 104 (46%) episodes required rescue therapy [94 episodes received medical rescue (16 cyclosporine/78 Infliximab) and 10 underwent direct colectomy]. In patients receiving medical rescue therapy, 16 (17%) underwent colectomy during same admission and 28 (29.8%) underwent colectomy by 12 months. On multivariable analysis, UCEIS score at admission [Coef 0.100 (0.02-0.17), p 0.011] and CRP on Day 3 post-rescue therapy [Coef 0.004 (0.0007-0.007), p 0.018] were significant for predicting colectomy during the same admission. A score with 1 point for each variable (UCEIS score ≥ 7 and CRP value of ≥ 22 mg/L on day 3 post medical rescue therapy) was developed. A score of 2 points had sensitivity 57%, specificity 97%, PPV 80%, NPV 91%, accuracy 89% for predicting colectomy during the same admission and sensitivity 33%, specificity 94%, PPV 80%, NPV 67%, accuracy 69% for predicting colectomy at 12 months. Conclusion UCEIS and CRP on day 3 after rescue therapy are predictors of non-response to medical rescue therapy and need for colectomy during the admission for the ASUC episode. Combination of UCEIS ≥ 7 and CRP ≥ 22mg/L on day 3 post medical rescue therapy has a PPV of 80% for colectomy during same admission and at 12 months. The score can be used to make decisions about colectomy or further medical rescue therapy.

scholarly journals P631 Predictors of vedolizumab treatment persistence in bio-naïve ulcerative colitis patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S523-S524
Author(s):  
T E Ritter ◽  
H E Sarles ◽  
S A Mehta ◽  
L J Van Anglen
Keyword(s):  
Ulcerative Colitis ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Maintenance Therapy ◽  
Clinical Response ◽  
Disease Duration ◽  
Biologic Therapy ◽  
First Line ◽  
Treatment Persistence ◽  
Oral Agents

Abstract Background Vedolizumab (VDZ) is increasingly being positioned as first-line biologic therapy for the treatment of inflammatory bowel disease (IBD) in adults, particularly for ulcerative colitis (UC). Identifying a certain subset of bio-naïve UC patients most likely to benefit from VDZ and remain on long-term maintenance therapy is important. The purpose of this study was to evaluate predictors of VDZ treatment persistence at 12 months in real-world clinical practice. Methods We performed a retrospective review of all adult (≥18 years) bio-naïve UC patients started on VDZ at US gastroenterology physician office infusion centres. Data collection included baseline demographics, VDZ therapy, concomitant oral agents, disease severity, and disease activity scores using the partial Mayo score (pMayo). Disease severity was characterised by prior IBD-related surgery and IBD-related healthcare resource utilisation within 1 year of VDZ initiation. Clinical response was assessed at baseline, 6 weeks, and 14 weeks and defined as a pMayo reduction of ≥2 points. Patients were divided into two cohorts, those persisting on VDZ at 12 months and those discontinuing VDZ prior to 12 months. Logistic regression analysis was used to determine predictors associated with persistence. Results A total of 141 UC patients receiving VDZ as first-line biologic therapy were identified: mean age 44 ± 14.5 years, male gender 82 (58%), median disease duration 5.5 (IQR 1.6–13.3) years. VDZ treatment persistence at 12 months was observed in 102 (72%) patients (Figure 1). The remaining 39 patients discontinued VDZ within the first 12 months. Amongst those who discontinued VDZ, reasons included lack or loss of response in 35 (90%), antibodies in 3 (8%), and intolerance in 1 (3%). In the logistic regression analysis, the only factor associated with VDZ treatment persistence was clinical response at 14 weeks (OR 6.5 [95% CI 2.9–14.5]). No other variables (age, gender, smoking status, disease duration, concomitant oral agents, or severity of illness) influenced persistence at 12 months. Conclusion Almost three-fourths of bio-naïve UC patients treated with vedolizumab experienced treatment persistence at 12 months. Our data suggest that response to induction may be used to predict those who will remain on maintenance therapy.

scholarly journals P536 Early prediction of intravenous corticosteroid therapy failure in moderate–severe ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S458-S458
Author(s):  
A Croft ◽  
A Lord ◽  
G Radford-Smith
Keyword(s):  
Ulcerative Colitis ◽  
High Risk ◽  
Clinical Outcomes ◽  
Corticosteroid Therapy ◽  
Risk Score ◽  
Risk Scores ◽  
Albumin Concentration ◽  
Therapy Failure ◽  
Severe Ulcerative Colitis ◽  
Intravenous Corticosteroid

Abstract Background An episode of acute severe ulcerative colitis (UC) is a watershed event during the disease course with a heightened risk of colectomy during and following these episodes.1 The prompt identification of these events followed by the early implementation of appropriate treatment is essential to obtaining the best clinical outcomes for these unwell patients. The majority of published risk scores predicting the important clinical outcomes of intravenous corticosteroid therapy failure and colectomy-by-discharge rely on clinical data from days 1–3 of therapy.2 There is a paucity of tools that allow for a simple and individualised prediction of risk of corticosteroid therapy failure during the earliest stages of admission. Methods Data were prospectively obtained from 349 presentations of moderate–severe UC requiring hospital admission to a tertiary referral hospital. The failure of intravenous corticosteroid therapy was strictly defined by the (Oxford) Day 3 and Day 7 criteria.3 Seventeen clinical, laboratory and endoscopic variables all available within 24 h of hospital presentation were assessed for their ability to differentiate intravenous corticosteroid therapy responders from non-responders. A stepwise generalised linear model was formulated based on the results of the initial univariate analyses. Results Intravenous corticosteroid therapy failure occurred in 208/349 (60%) of presentations. The formulated risk score included the variables of oral corticosteroid therapy failure, bowel frequency and serum albumin concentration with or without the Mayo endoscopic subscore (MES). With the addition of the MES, the area under the curve (AUC) of the risk score was 0.758. When the positive predictive value of the score (threshold) for correctly predicting intravenous corticosteroid therapy failure was set at 85%, 105/275 (38%) of presentations with available data were identified as high risk for corticosteroid therapy failure (Figure 1). Conclusion This practical risk assessment tool provides clinicians with a personalised prediction of the likelihood of success of a course of intravenous corticosteroid therapy in moderate–severe UC. It enables the identification of individuals at high risk of treatment failure who may be suitable for consideration of early treatment escalation or screening for appropriate clinical trials. References

scholarly journals Two Cases of Severe Ulcerative Colitis with Colonic Dilatation Resolved with Tacrolimus Therapy

2015 ◽  
Vol 9 (2) ◽  
pp. 272-277
Author(s):  
Ryohei Hayashi ◽  
Yoshitaka Ueno ◽  
Shinji Tanaka ◽  
Shintaro Sagami ◽  
Kenta Nagai ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Abdominal Pain ◽  
Corticosteroid Therapy ◽  
Transverse Colon ◽  
Intestinal Tract ◽  
Rescue Therapy ◽  
Severe Ulcerative Colitis ◽  
X Ray ◽  
Emergency Colectomy ◽  
Tacrolimus Therapy

We report 2 cases of ulcerative colitis (UC) with intestinal tract dilatation treated with tacrolimus. They were 53- and 64-year-old males, who had been admitted to local hospitals for increasing severity of their UC symptoms. Treatment for severe UC was immediately started, but both cases were refractory to corticosteroid therapy; they were then transferred to our hospital. When they were referred to our hospital, they had frequent bloody diarrhea, fever, severe abdominal pain, and even dilatation of the transverse colon on abdominal X-ray test. They were treated with oral tacrolimus medication, and their symptoms improved immediately. Dilatation of the transverse colon was improved on plain X-ray at 2 weeks after starting therapy, and emergency colectomy could be avoided. These 2 cases may suggest that tacrolimus is effective for UC with colonic dilatation as a rescue therapy.

Inpatient Management of Acute Severe Ulcerative Colitis

2019 ◽  
Author(s):  
David I Fudman ◽  
Lindsey Sattler ◽  
Joseph D Feuerstein
Keyword(s):  
Ulcerative Colitis ◽  
Rescue Therapy ◽  
Disease Process ◽  
Corticosteroid Treatment ◽  
Coordinated Care ◽  
Severe Ulcerative Colitis ◽  
Intravenous Corticosteroid ◽  
Inpatient Management ◽  
The Common ◽  
Time Of Admission

Acute severe ulcerative colitis (ASUC) is a potentially lifethreatening presentation of ulcerative colitis that in nearly all cases requires inpatient management and coordinated care from hospitalists, gastroenterologists, and surgeons. Even with ideal care, a substantial proportion of patients will ultimately require colectomy, but most patients can avoid surgery with intravenous corticosteroid treatment and if needed, appropriate rescue therapy with infliximab or cyclosporine. In-hospital management requires not only therapies to reduce the inflammation at the heart of the disease process, but also to avoid complications of the disease and its treatment. Care for ASUC must be anticipatory, with patient education and evaluation starting at the time of admission in advance of the possible need for urgent medical or surgical rescue therapy. Here we outline a general approach to the treatment of patients hospitalized with ASUC, highlighting the common pitfalls and critical points in management.

scholarly journals Gene Expression Changes Associated with Resistance to Intravenous Corticosteroid Therapy in Children with Severe Ulcerative Colitis

PLoS ONE ◽  
2010 ◽  
Vol 5 (9) ◽  
pp. e13085 ◽  
Author(s):  
Boyko Kabakchiev ◽  
Dan Turner ◽  
Jeffrey Hyams ◽  
David Mack ◽  
Neal Leleiko ◽  
...  
Keyword(s):  
Gene Expression ◽  
Ulcerative Colitis ◽  
Corticosteroid Therapy ◽  
Severe Ulcerative Colitis ◽  
Intravenous Corticosteroid

scholarly journals Acute severe ulcerative colitis: management advice for internal medicine and emergency physicians

2021 ◽  
Author(s):  
Konstantina Rosiou ◽  
Christian Philipp Selinger
Keyword(s):  
Ulcerative Colitis ◽  
Rescue Therapy ◽  
Medical Emergency ◽  
Close Monitoring ◽  
Surgical Morbidity ◽  
Severe Ulcerative Colitis ◽  
General Management ◽  
Management Measures ◽  
Management Advice ◽  
Team Setting

AbstractAcute severe ulcerative colitis is a medical emergency that warrants in-patient management. This is best served within a multidisciplinary team setting in specialised centres or with expert consultation. Intravenous corticosteroids remain the cornerstone in the management of ASUC and should be initiated promptly, along with general management measures and close monitoring of patients. Unfortunately, one-third of patients will fail to respond to steroids. Response to intravenous corticosteroid therapy needs to be assessed on the third day and rescue therapies, including cyclosporine and infliximab, should be offered to patients not responding. Choice of rescue therapy depends on experience, drug availability and factors associated with each individual patient, such as comorbidities, previous medications or contra-indications to therapy. Patients who have not responded within 7 days to rescue therapy must be considered for surgery. Surgery is a treatment option in ASUC and should not be delayed in cases of failure of medical therapy, because such delays increase surgical morbidity and mortality. This review summarises the current management of acute severe ulcerative colitis and discusses potential future developments.

scholarly journals Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases

2020 ◽  
Vol 8 ◽  
Author(s):  
Chen Dong ◽  
Minhui Zhu ◽  
Luguang Huang ◽  
Wei Liu ◽  
Hengxin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Treatment Failure ◽  
Logistic Regression Analysis ◽  
Disease Duration ◽  
Multivariate Logistic Regression Analysis ◽  
Tissue Expansion ◽  
Multivariate Logistic Regression ◽  
Hematoma Evacuation

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p < 0.001), larger volume of expander (200–400 ml vs <200 ml; OR, 1.74; p = 0.032; >400 ml vs <200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year, expander volume of >200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.

Sign in / Sign up

Export Citation Format

Share Document