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Severe ulcerative colitis: prospective study of parameters determining outcome
Sanjay Kumar1, Uday C Ghoshal, Rakesh Aggarwal
1Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Journal of Gastroenterology and Hepatology
|October 16, 2004
Summary
Predicting ulcerative colitis (UC) exacerbation treatment failure is crucial. Clinical and laboratory markers can help identify patients needing closer monitoring or alternative therapies, potentially improving outcomes and reducing colectomy rates.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Ulcerative colitis (UC) exacerbations frequently necessitate colectomy or lead to mortality.
- Predictive factors for medical treatment failure in UC exacerbations are not well-established through multivariate analysis.
Purpose of the Study:
- To identify predictors of medical treatment failure in patients hospitalized with ulcerative colitis exacerbations.
- To explore the utility of clinical and laboratory parameters in predicting treatment outcomes.
Main Methods:
- Prospective recording of demographic, clinical, and laboratory data within 48 hours of admission for 55 UC exacerbation episodes.
- Standard medical treatment including intravenous hydrocortisone, antibiotics, and fluids.
- Comparison of treatment failure cases (surgery, death, deterioration) with treatment responders using univariate and multivariate analyses.
Main Results:
- Medical treatment failed in 10 of 55 episodes, with 8 requiring surgery and 2 deaths.
- Univariate analysis identified younger age, pedal edema, colonic diameter, low hemoglobin/albumin, high C-reactive protein, fibrin degradation product, low fibrinogen, prolonged prothrombin time, fulminant disease, and high clinical activity index as significant predictors.
- Multivariate analysis confirmed the significance of colonic diameter, low hemoglobin, high C-reactive protein, low serum fibrinogen, prolonged prothrombin time, fulminant disease, and high clinical activity index.
Conclusions:
- A scoring system integrating clinical and laboratory parameters may predict medical treatment failure in UC exacerbations.
- Early identification of high-risk patients can potentially guide treatment strategies and improve patient management.