Lowering the C-Reactive Protein (CRP) Threshold Improves Risk Stratification in Acute Ulcerative Colitis: A...

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease Research
• Clinical Medicine

Background:

• Real-world data indicate non-acute severe ulcerative colitis (NASUC) patients have high intravenous corticosteroid (IVCS) failure rates, comparable to acute severe ulcerative colitis (ASUC).
• Existing management guidelines do not specifically address NASUC.
• This gap highlights a need to better understand and manage NASUC patients.

Purpose of the Study:

• To compare inpatient medical therapy and colectomy risk between TWC-positive ASUC and NASUC patients.
• To assess if a reduced C-reactive protein (CRP) threshold (≥12 mg/L) improves the identification of high-risk NASUC patients.
• To inform management strategies for hospitalized UC patients.

Main Methods:

• Analysis of 503 consecutive acute ulcerative colitis admissions.
• Classification of patients into ASUC (meeting TWC criteria) and NASUC (not meeting TWC criteria).
• Propensity score matching (PSM) to compare colectomy risk between ASUC and NASUC groups, adjusting for key clinical factors.

Main Results:

• 145 (29%) admissions were classified as NASUC, predominantly with high stool frequency without systemic toxicity.
• A reduced CRP threshold (≥12 mg/L) would have reclassified 26% of NASUC patients, capturing 43% of those requiring colectomy within one year.
• PSM revealed no significant difference in colectomy rates between ASUC and NASUC at 30 days, 90 days, or 1 year.

Conclusions:

• Non-acute severe ulcerative colitis (NASUC) is a significant clinical entity, not to be underestimated.
• When matched for disease severity and treatment, colectomy risks are comparable between ASUC and NASUC inpatients.
• Implementing a lower CRP threshold (≥12 mg/L) enhances the detection of high-risk NASUC patients currently missed by standard criteria.