The failure rate of medical therapy in severe ulcerative colitis is high.
It would be useful to identify patients who are unlikely to respond at an early stage to intravenous corticosteroid therapy.
In this study, doctors from Scotland recruited 167 consecutive patients with severe ulcerative colitis between 1995 and 2002.
|40% of patients failed to respond.|
|Alimentary Pharmacology and Therapeutics|
They used multiple logistic regression to analyze parameters within the first 3 days of medical therapy. They also used statistical modeling to calculate a risk score of the likelihood of medical failure.
Overall, 40% of patients failed to respond to medical therapy.
The team identified mean stool frequency and colonic dilatation within the first 3 days, and hypoalbuminemia as independent predictors of outcome. The doctors calculated a numerical risk score based on these variables.
They found that patients with scores of 0 to 1, 2 to 3 and 4 had a medical therapy failure rate of 11%, 43%, and 85%, respectively.
Receiver-operator characteristic analysis of this score yielded area under curve of 0.88, with a sensitivity of 85% and specificity of 75% using score 4 in predicting nonresponse.
Dr Ho and colleagues concluded, "This risk score allows the early identification of patients with severe ulcerative colitis who would be suitable for second-line medical therapy or surgery".