Corticosteroid exposure prior to admission and predicting need for rescue therapy in acute severe ulcerative colitis

Internal Medicine Journal
Alex BarnesRéme Mountifield

Abstract

Steroid exposure has been associated with poorer outcomes following colectomy in acute severe ulcerative colitis (ASUC). Our centre aimed to examine the effect of prolonged oral corticosteroid therapy immediately prior to admission on the likelihood of requiring rescue therapy along with predictors of intravenous corticosteroid failure on day one of admission. A retrospective case note and electronic record review was conducted at a tertiary inflammatory bowel disease referral centre of admissions for ASUC meeting Truelove and Witts criteria from 2013 to 2019.The data was analysed for the effect of pre-admission steroid exposure on need for rescue therapy and for predictors of intravenous corticosteroid failure. 92 admissions were identified for ASUC meeting Truelove and Witts criteria. Over one week of steroid therapy prior to admission was associated with need for rescue therapy and trended to significance for colectomy at admission and at twelve months. A generalised linear model was constructed with multivariate regression significant for over one week of steroid therapy prior to admission, endoscopic Mayo score, and albumin. The AUROC for this model was 0.86. Prolonged steroid use prior to ASUC admission is a significant p...Continue Reading

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