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Early predictors of outcomes of corticosteroid treatment for severe ulcerative colitis

A study in this month's issue of the Scandanavian Journal of Gastroenterology identifies early predictors of responses and clinical outcomes of corticosteroid treatment for severe ulcerative colitis.

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Patients with severe ulcerative colitis have a high risk of requiring colectomy or resorting to a second-line treatment.

However, neither clinical outcomes nor factors predictive of poor response have been clearly established in the treatment of severe ulcerative colitis.

Dr Jian-Ming Xu and colleagues from China assessed prospectively the effects and predictors of corticosteroids use in clinical outcomes of SUC during 1 year of follow-up.

Consecutive inpatients with severe ulcerative colitis, who had been treated with intravenous corticosteroids, were enrolled.

Patients were monitored by clinical, laboratory, and endoscopic examinations, and the data were recorded for 1 year.

Univariate and multivariate analyses were performed at 1 week.

Short-term response rates to intravenous infliximab in severe ulcerative colitis were 78%
Scandanavian Journal of Gastroenterology

The research team found 23% nonresponders at 7 days.

The team identified several predictors that were associated with nonresponse to corticosteroids.

These included Mayo Score at baseline, partial Mayo Score, number of bowel movements, blood presence in stool, abdominal pain, and levels of C-reactive protein (CRP), hemoglobin (Hgb), platelet count (PLT), and erythrocyte sedimentation rate (ESR) on day 3.

The researchers found that the Partial Mayo Score at day 3 was an independent predictor of outcome.

A total of 12 patients underwent colectomy within 1 year.

The team noted that the short-term response rates to intravenous cyclosporin and infliximab in severe ulcerative colitis were 71%, and 78%, respectively.

Dr Xu's team concludes, "Many patients with severe ulcerative colitis eventually became refractory to or dependent on corticosteroids."

"The Mayo score and laboratory characteristics were factors useful in predicting short-term outcome of corticosteroids treatment."

"Secondary medical therapy can help avoid emergency surgery."

Scand J Gastroenterol 2014: 49(4): 424-433
11 April 2014

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