title: History of medical hospitalization predicts future need for colectomy in patients with ulcerative colitis.
abstract: BACKGROUND
  Patients who require hospitalization for the management of ulcerative colitis (UC) may represent a subset with severe disease. These patients may be more likely to require future colectomy. There are limited data examining whether medical hospitalization is predictive of subsequent colectomy.
  
  
  METHODS
  This was a retrospective case-control study utilizing the inflammatory bowel disease center database at our academic referral center. Cases comprised UC patients who underwent colectomy for disease refractory to medical management. The control population was comprised of all patients with UC who had not undergone colectomy. Multivariate logistic regression was used to identify independent predictors of requiring colectomy.
  
  
  RESULTS
  There were a total of 246 UC patients included in our study, with 103 being hospitalized sometime in their disease course (41.9%). A total of 27 patients underwent colectomy (11%). Colectomy patients were significantly more likely to have been on infliximab therapy (51.8% versus 22.4%, P = 0.001) but no more likely to have been on immunomodulator therapy (74.1% versus 59.4%, P = 0.14). Patients who required medical hospitalization for UC were more likely to require future colectomy (20.4% versus 4.2%, P < 0.001) than those who had not required hospitalization. On multivariate analysis, requiring medical hospitalization for management of UC (odds ratio [OR] 5.37, 95% confidence interval [CI] 2.00-14.46) and ever requiring infliximab therapy (OR 3.12, 95% CI 1.21-8.07) were independent predictors of colectomy.
  
  
  CONCLUSIONS
  Requiring medical hospitalization for the management of disease activity in UC is an independent predictor of the need for colectomy. Future studies will determine whether aggressive medical management may modify the need for colectomy in this cohort.
authors.affiliation: Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.forename: Mazen
authors.initials: M
authors.lastname: Issa
authors.forename: Dawn B
authors.initials: DB
authors.lastname: Beaulieu
authors.forename: Sue
authors.initials: S
authors.lastname: Skaros
authors.forename: Josh F
authors.initials: JF
authors.lastname: Knox
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lemke
authors.forename: Jeanne
authors.initials: J
authors.lastname: Emmons
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Lundeen
authors.forename: Mary F
authors.initials: MF
authors.lastname: Otterson
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D005544:Forecasting; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors