Prognosis of severe attacks in ulcerative colitis: effect of intensive medical treatment.
BACKGROUND
Severe attacks of ulcerative colitis have a high risk of colectomy.


OBJECTIVE
To evaluate the effects of standard medical management and to identify the clinical and laboratory variables capable of predicting the clinical outcome.


METHODS
Prospective study monitoring the clinical and laboratory variables in 67 patients with severe colitis. Therapy consisted of prednisone, cyclosporin if no response, and azathioprine for maintenance. End-points were colectomy or remission. Logistic regression analysis was applied for statistical evaluation.


RESULTS
Fourteen (20%) patients required colectomy, 34 (50%) patients achieved remission with steroids, 25 (37%) patients received cyclosporin, 19 (76%) with benefit. Increased body temperature, pulse rate, sedimentation rate and C-reactive protein levels on admission were significantly associated with colectomy. Sedimentation rate greater than 75 mm/h and body temperature exceeding 38 degrees C at admission had 4.6- and 8.8-fold increased risk of colectomy. Less than 40% reduction in the bowel movements within 5 days predicted no response to steroids. Azathioprine maintained remission in 70% of the patients.


CONCLUSIONS
Elevated sedimentation rate and fever at day 1 best predict colectomy in severe colitis. Less than 40% reduction in the bowel movements at day 5 predicts no response to steroids. Cyclosporin has a high rate of success in acute attacks and azathioprine in maintaining remission.
Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani 2, 35100 Padova, Italy.
L
L
Benazzato
R
R
D'Incà
F
F
Grigoletto
E
E
Perissinotto
V
V
Medici
I
I
Angriman
G C
GC
Sturniolo
D001379:Azathioprine / Q000627:therapeutic use; D001799:Blood Sedimentation; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D011674:Pulse; D012074:Remission Induction; D016896:Treatment Outcome
D016572:Cyclosporine; D002097:C-Reactive Protein; D001379:Azathioprine; D011241:Prednisone