Delayed Corticosteroid Treatment for Patients Requiring Hospitalization for Acute Inflammatory Bowel Disease...

While corticosteroids are not recommended for maintenance of remission in inflammatory bowel disease (IBD), they are quite effective for the induction of remission for both Crohn's disease (CD) and ulcerative colitis (UC). We aimed to evaluate if a delay in starting corticosteroids after presentation to the hospital for an acute IBD exacerbation increased the likelihood of poor outcomes.

Retrospective cohort study of IBD-related hospitalizations from 7 area hospitals in Austin, Texas between 2015 and 2020. Patients were included if admitted for an IBD flare and received corticosteroids. CD with intra-abdominal abscesses were excluded. Primary outcomes were length of stay (LOS), ICU stay, IBD-related surgery, and mortality.

Of 478 inpatients, 311 (65%) received corticosteroids within 12 h of arrival. ICU stays (4.2% vs. 5.4%, p = 0.88, early vs. late corticosteroids) and inpatient mortality (1.0% vs. 1.8%, p = 0.75) were not significantly different between groups. However, after adjustment for confounders, LOS (4.7 vs. 5.8 days, p = 0.027) was significantly shorter and IBD-related surgery (3.5% vs. 7.2%, p = 0.048) was reduced for those receiving corticosteroids early. On subgroup analysis, these findings remained significant only for patients with CD and not UC.

For patients admitted with IBD flares without associated abscess, there was an increased LOS and increased risk for IBD-related surgery if corticosteroid therapy was delayed > 12 h after arrival. Guidelines recommend treating acute flares without delay, but guidance on specifics of timing is absent. Our data suggests that treatment should be started within 12 h of presentation, particularly for those with CD.