title: Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit.
abstract: BACKGROUND
  Approximately one third of patients with acute severe ulcerative colitis (ASUC) fail response to steroids. Ciclosporin and anti-TNFα are proven second-line therapies, but evidence of their efficacy has come mainly from tertiary centres and/or selective clinical trial recruitment.
  
  
  OBJECTIVE
  To assess ASUC outcomes in a large unselected cohort.
  
  
  METHODS
  UK-wide audits of IBD care were conducted in 2008 (209 hospital sites) and 2010 (198 hospital sites), covering >87% of admitting hospitals. Each site entered data from 20 consecutive UC admissions onto a web-based proforma. Admissions included 852 (2008) and 984 (2010) with ASUC, accounting for 35% and 39% of UC admissions, respectively.
  
  
  RESULTS
  ASUC in-hospital mortality was 1.2% in 2008; 0.7% in 2010 (P = 0.22). Response to first-line steroid therapy was 61% (2008); 58% (2010) and mortality was higher in non-responders: 2008: 2.9% (9/315) vs. 0.19% (1/537; P < 0.001); 2010: 1.8% (7/391) vs. 0.0% (0/593; P = 0.002). In 2010, more patients (56%) received second-line medical therapy than in 2008 (47%, P = 0.02). In-hospital mortality was similar to second-line medical therapy vs. surgery without further medical therapy; 2008: 2.7% vs. 2.8%, P = 0.99; 2010: 0.9% vs. 3.1%, P = 0.17. Second-line therapy response was more frequently observed with anti-TNFα than ciclosporin: (2008: 76% vs. 46%, P < 0.001; 2010: 80% vs. 58%, P < 0.001).
  
  
  CONCLUSIONS
  Mortality in acute severe ulcerative colitis was low, but higher in steroid non-responders. Patients treated with second-line medical therapies had no higher risk of in-hospital mortality than those undergoing surgery. Second-line 'rescue' medical therapy usage is increasing; however, ciclosporin response rates were relatively low.
authors.affiliation: Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.
authors.forename: R W
authors.initials: RW
authors.lastname: Lynch
authors.forename: D
authors.initials: D
authors.lastname: Lowe
authors.forename: A
authors.initials: A
authors.lastname: Protheroe
authors.forename: R
authors.initials: R
authors.lastname: Driscoll
authors.forename: J M
authors.initials: JM
authors.lastname: Rhodes
authors.forename: I D R
authors.initials: ID
authors.lastname: Arnott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha; D016572:Cyclosporine