What are the factors that affect hospitalization and surgery for aggravation of ulcerative colitis?

We investigated factors that may affect hospitalization and surgery in patients presenting with aggravation of ulcerative colitis (UC).

This study included 222 UC patients who had visited our hospital regularly since 2000 (127 men, 95 women; mean age at onset, 34±16 years). We divided the patients into groups according to whether or not they were hospitalized for aggravation of UC (hospitalized group, n=75; nonhospitalized group, n=147), compared the clinical features and clinical courses between the two groups, and also analyzed the cumulative rates of surgery. Then, only the 75 patients of the hospitalized group were divided into two groups for a subanalysis (colectomy group, n=25; noncolectomy group, n=50).

In the hospitalized group, the rates of use of steroids and thiopurine immunomodulators were significantly higher, and the rates of concurrent cytomegalovirus (CMV) infection and surgery for UC aggravation were also significantly higher. Multivariate analysis identified CMV infection [odds ratio (OR), 8.2; 95% confidence interval (CI), 1.91-35.33; P=0.0047] and steroid use (OR, 4.4; 95% CI, 1.30-14.93; P=0.0170) as risk factors for hospitalization because of UC aggravation. Moreover, the cumulative rate of surgery was significantly higher in the hospitalized group (P<0.0001). Multivariate analysis as part of the subanalysis identified the use of thiopurine immunomodulators as a factor for avoidance of surgery (OR, 0.2; 95% CI, 0.08-0.67; P=0.0072).

Concurrent CMV infection was associated with an eight-fold increase in the risk of hospitalization for UC aggravation. In contrast, maintenance therapy with thiopurine immunomodulators reduced the risk of surgery by 80%.