Inflammatory bowel diseases · 2026
Acute severe ulcerative colitis without systemic toxicity: A retrospective multicenter cohort study suggesting refining the definition of acute severe ulcerative colitis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Ørtoft Frederik, Nissen Mathilde Jepsen, Kjeldsen Jens, Steenholdt Casper, Ainsworth Mark
Аннотация
BACKGROUND: Acute severe ulcerative colitis (ASUC) is defined by the Truelove and Witts (TW) criteria. However, contemporary practice has shifted toward earlier admission and treatment escalation in advanced therapy-experienced patients, resulting in a growing subgroup hospitalized for ASUC who do not fulfill TW (non-TW ASUC). This population remains poorly characterized.
METHODS: Retrospective cohort study of all patients hospitalized for ASUC and treated with intravenous corticosteroids at a Danish tertiary center until 2023. The primary outcome of 1-year colectomy was assessed in an independent validation cohort.
RESULTS: Of 109 included patients, 80 (73%) fulfilled TW criteria and 29 (27%) did not. Non-TW ASUC patients were less often female (28% vs 63%; P < .01), were less frequently steroid-naïve (21% vs 48%; P < .05), and presented with lower systemic inflammation (C-reactive protein median 7 mg/L vs 34 mg/L; P < .001; hemoglobin 13.7 g/dL vs 12.2 g/dL; P < .001; albumin 41 g/L vs 38 g/L; P < .001). Colectomy-free survival and colectomy rates at 1, 3, and 12 months were comparable between non-TW and TW ASUC (14% vs 10%, 21% vs 16%, and 29% vs 19%, respectively; P > .05). Results were similar in the validation cohort (n = 43). Medical rescue therapy use, tumor necrosis factor inhibitor exposure, and readmission rates through 1 year did not differ significantly. Prognostic indices (Ho, Lindgren, Travis) similarly identified high-risk patients across both groups. Non-TW patients had shorter hospital stay (mean 6.5 days vs 8.6 days; P < .01).
CONCLUSION: Non-TW ASUC shows a disease course and outcomes comparable to TW ASUC, underscoring an equally severe and comparable condition. These findings emphasize a need to broaden ASUC definitions to reflect contemporary practice.
METHODS: Retrospective cohort study of all patients hospitalized for ASUC and treated with intravenous corticosteroids at a Danish tertiary center until 2023. The primary outcome of 1-year colectomy was assessed in an independent validation cohort.
RESULTS: Of 109 included patients, 80 (73%) fulfilled TW criteria and 29 (27%) did not. Non-TW ASUC patients were less often female (28% vs 63%; P < .01), were less frequently steroid-naïve (21% vs 48%; P < .05), and presented with lower systemic inflammation (C-reactive protein median 7 mg/L vs 34 mg/L; P < .001; hemoglobin 13.7 g/dL vs 12.2 g/dL; P < .001; albumin 41 g/L vs 38 g/L; P < .001). Colectomy-free survival and colectomy rates at 1, 3, and 12 months were comparable between non-TW and TW ASUC (14% vs 10%, 21% vs 16%, and 29% vs 19%, respectively; P > .05). Results were similar in the validation cohort (n = 43). Medical rescue therapy use, tumor necrosis factor inhibitor exposure, and readmission rates through 1 year did not differ significantly. Prognostic indices (Ho, Lindgren, Travis) similarly identified high-risk patients across both groups. Non-TW patients had shorter hospital stay (mean 6.5 days vs 8.6 days; P < .01).
CONCLUSION: Non-TW ASUC shows a disease course and outcomes comparable to TW ASUC, underscoring an equally severe and comparable condition. These findings emphasize a need to broaden ASUC definitions to reflect contemporary practice.