Outcomes of acute severe ulcerative colitis at initial presentation

20-25% of patients with ulcerative colitis (UC) will experience at least one episode of acute severe ulcerative colitis (ASUC). Up to 20% of nonresponders to medical treatment require surgery during the index episode. For approximately one-third of the patients, ASUC is the first manifestation of the disease, presenting unique challenges.

Retrospective cohort study including 185 patients hospitalized with ASUC. We aim to compare the clinical outcomes between patients with new-onset and established UC.

62 (33.5%) patients had new-onset, while 123 (66.5%) had established UC. Demographic and baseline clinical characteristics were similar between groups. Patients with new-onset UC experienced longer hospitalizations (19 ± 22 vs. 12 ± 11 days; P  = 0.002), longer delay until receiving rescue therapy [11 vs. 6 days (interquartile range : 6-8 days); P  = 0.014] and more severe bacterial infections (16 vs. 4%; P  = 0.005). We found no significant differences in steroid response ( P  = 0.719), need for rescue therapy ( P  = 0.522), response to rescue therapy ( P  = 0.234), colectomy ( P  = 0.655), mortality ( P  = 0.516), and hospital readmission ( P  = 0.929) between groups. After 1 year, colectomy or death occurred in 13.5% of patients. Independent predictors of adverse outcomes included active smoking, extensive colitis, the need for rescue therapy, and severe bacterial infections - but not new-onset disease.

Major clinical outcomes were similar between patients with new-onset and established UC.