The effect of pre-admission immunosuppression on colectomy rates in acute severe ulcerative colitis
Background: Patients on immunosuppression at the time of acute severe ulcerative colitis have been suggested to be at a higher risk of colectomy than those who are treatment-naïve. The aim of this study was to examine the effect of immunosuppressive therapy on the risk of colectomy. Method: We condu...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2018-11-01
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| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/1756284818809789 |
| _version_ | 1818413476279746560 |
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| author | Desmond Patrick James Doecke James Irwin Katherine Hanigan Lisa Simms Mariko Howlett Graham Radford-Smith |
| author_facet | Desmond Patrick James Doecke James Irwin Katherine Hanigan Lisa Simms Mariko Howlett Graham Radford-Smith |
| author_sort | Desmond Patrick |
| collection | DOAJ |
| description | Background: Patients on immunosuppression at the time of acute severe ulcerative colitis have been suggested to be at a higher risk of colectomy than those who are treatment-naïve. The aim of this study was to examine the effect of immunosuppressive therapy on the risk of colectomy. Method: We conducted a retrospective observational cohort study using prospective data examining the 30 day and 1 year colectomy rates of 200 consecutive patients with an index episode of acute severe ulcerative colitis as defined by the Truelove and Witts criteria. Results: Immunosuppression on admission was shown not to increase colectomy rate at 30 days post-admission (immunomodulator: p = 0.422, oral steroids: p = 0.555). A total of 24 patients underwent colectomy between 30 days and 1 year. A three-fold higher risk of colectomy at 1 year was seen in those requiring an immunomodulator prior to the index admission compared with those started de novo during the index admission [41% versus 14% odds ratio (OR): 2.93 (1.19–7.24 p = 0.016)]. Factors most predictive of colectomy at 30 days were abdominal radiographic colonic dilation ⩾5.5 cm, first presentation of ulcerative colitis, C-reactive protein ⩾ 45 mg/l on day 3 of therapy and bowel frequency ⩾8 on day 3. Conclusion: The need for an immunomodulator prior to admission with acute severe ulcerative colitis increases the medium-term colectomy rate by three-fold at 1 year. Prospective studies are needed to confirm these findings and develop strategies to reduce the high risk in this subgroup of patients. |
| first_indexed | 2024-12-14T11:03:48Z |
| format | Article |
| id | doaj.art-d487053ef7474ab281eb207b4e3a553c |
| institution | Directory Open Access Journal |
| issn | 1756-2848 |
| language | English |
| last_indexed | 2024-12-14T11:03:48Z |
| publishDate | 2018-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj.art-d487053ef7474ab281eb207b4e3a553c2022-12-21T23:04:39ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-28482018-11-011110.1177/1756284818809789The effect of pre-admission immunosuppression on colectomy rates in acute severe ulcerative colitisDesmond PatrickJames DoeckeJames IrwinKatherine HaniganLisa SimmsMariko HowlettGraham Radford-SmithBackground: Patients on immunosuppression at the time of acute severe ulcerative colitis have been suggested to be at a higher risk of colectomy than those who are treatment-naïve. The aim of this study was to examine the effect of immunosuppressive therapy on the risk of colectomy. Method: We conducted a retrospective observational cohort study using prospective data examining the 30 day and 1 year colectomy rates of 200 consecutive patients with an index episode of acute severe ulcerative colitis as defined by the Truelove and Witts criteria. Results: Immunosuppression on admission was shown not to increase colectomy rate at 30 days post-admission (immunomodulator: p = 0.422, oral steroids: p = 0.555). A total of 24 patients underwent colectomy between 30 days and 1 year. A three-fold higher risk of colectomy at 1 year was seen in those requiring an immunomodulator prior to the index admission compared with those started de novo during the index admission [41% versus 14% odds ratio (OR): 2.93 (1.19–7.24 p = 0.016)]. Factors most predictive of colectomy at 30 days were abdominal radiographic colonic dilation ⩾5.5 cm, first presentation of ulcerative colitis, C-reactive protein ⩾ 45 mg/l on day 3 of therapy and bowel frequency ⩾8 on day 3. Conclusion: The need for an immunomodulator prior to admission with acute severe ulcerative colitis increases the medium-term colectomy rate by three-fold at 1 year. Prospective studies are needed to confirm these findings and develop strategies to reduce the high risk in this subgroup of patients.https://doi.org/10.1177/1756284818809789 |
| spellingShingle | Desmond Patrick James Doecke James Irwin Katherine Hanigan Lisa Simms Mariko Howlett Graham Radford-Smith The effect of pre-admission immunosuppression on colectomy rates in acute severe ulcerative colitis Therapeutic Advances in Gastroenterology |
| title | The effect of pre-admission immunosuppression on colectomy rates in acute severe ulcerative colitis |
| title_full | The effect of pre-admission immunosuppression on colectomy rates in acute severe ulcerative colitis |
| title_fullStr | The effect of pre-admission immunosuppression on colectomy rates in acute severe ulcerative colitis |
| title_full_unstemmed | The effect of pre-admission immunosuppression on colectomy rates in acute severe ulcerative colitis |
| title_short | The effect of pre-admission immunosuppression on colectomy rates in acute severe ulcerative colitis |
| title_sort | effect of pre admission immunosuppression on colectomy rates in acute severe ulcerative colitis |
| url | https://doi.org/10.1177/1756284818809789 |
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