Long-term outcome after admission for acute severe ulcerative colitis in Oxford: the 1992-1993 cohort.
BACKGROUND
To determine the long-term outcome of patients admitted with acute severe colitis (ASC) who avoided colectomy on the index admission, a retrospective cohort study was performed.


METHODS
Patients admitted for intensive treatment of ASC in 1992-1993 previously described for a predictive index of short-term outcome in severe ulcerative colitis (UC) were followed for a median 122 months (range 3-144). Complete responders (CR) to intensive therapy had <3 nonbloody stools/day on day 7 of the index admission; incomplete responders (IR) were all others who avoided colectomy on that admission. Main outcome measures were colectomy-free survival, time to colectomy, and duration of steroid-free remission.


RESULTS
In all, 6/19 CR (32%) came to colectomy compared to 10/13 IR (P = 0.016; relative risk 3.33, 95% confidence interval [CI] 1.12-9.9). The median +/- interquartile range time to colectomy was 28 +/- 47 months (range 6-99) for CR who came to colectomy versus 7.5 +/- 32 (3-72) months for IR (P = 0.118). Among the IR, 7/13 came to colectomy within 12 months, and all within 6 years from the index admission. The longest period of steroid-free remission was 42 +/- 48 (0-120) months for CR, but 9 +/- 20 (1-35) months for IR (P = 0.011).


CONCLUSIONS
One week after admission with ASC in the prebiologic era, IRs had a 50% chance of colectomy within a year and 70% within 5 years, despite cyclosporin and azathioprine where appropriate. The maximum duration of remission in CRs was almost 5 times longer than IRs. It is unknown whether biologics change the long-term outcome.
Bojic
D
D
Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
Radojicic
Z
Z
Nedeljkovic-Protic
M
M
Al-Ali
M
M
Jewell
D P
DP
Travis
S P L
SP
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D017281:Cost of Illness; D016572:Cyclosporine / Q000627:therapeutic use; D004739:England / Q000453:epidemiology; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011237:Predictive Value of Tests; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors
D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D001379:Azathioprine