P190 THE PATTERN AND OUTCOME OF ACUTE SEVERE ULCERATIVE COLITIS

Abstract

The initial outcome, likelihood of recurrence and long-term prognosis of acute severe ulcerative colitis (ASUC) are measures of the burden of disease and therefore influence therapeutic decisions. There are few data on the prevalence and characteristics of ASUC, although the UK National IBD Audit (2006) estimates that 1 patient is admitted to every UK hospital each month. Methods and Aims: The aims of this study were to define these characteristics and determine if the outcome was related to the number of Truelove and Witts' criteria (TWC) on admission. A systematic, retrospective study of all patients with UC diagnosed in Oxford from 1950-2007 was performed. Non-Oxford diagnosed patients were excluded from the analysis. ASUC as defined by TWC was the indication for admission for intensive therapy throughout this period. Demographic, clinical and biomedical characteristics on admission were recorded, with medical or surgical treatment and outcome. Results: 747 patients with UC diagnosed in Oxford between 1950-2007 (median follow up 129.0 months, range 0-647.6 months) were evaluated out of a total cohort of 1827 patients. Of these, 27.6% (206/747) had ASUC as defined by TWC. There were 317 admissions in 206 patients. Age at latest follow up in those with an episode of ASUC was significantly lower than those without an episode (49.6 vs 53.1 yr, p=0.007), but there was no significant difference in gender or duration of disease. 49.3% were admitted within 1 year of initial diagnosis (median time to admission 12.7 months, range 0-453.4 months). 67% had a single episode, 20% had two, and 13% three or more episodes. 87/227 (38.7%) of patients with one or more episodes of ASUC had a colectomy. The likelihood of colectomy on the first, second, third, fourth and fifth admissions was 19.9%, 29.0%, 36.6%, 38.2%, 39.8% respectively. Although half of all colectomies (36/75) occurred on the first admission the colectomy rate on the first admission (48/152, 31.5%) was lower than on the second or subsequent admissions (39/75, 52.0%; OR 2.35, 95% CI 1.33-4.14, p=0.003). 18/147 patients who had a single TWC in addition to a bloody stool frequency 6/day required colectomy, whilst 61/170 patients who had 2 additional TWC required colectomy (p=1.2x10 - ; OR 4.01, 95% C.I. 2.24-7.19) (+1 additional criterion = 18/147 (12.2%); +2 = 30/99 (31.3%); +3 =27/59 (45.8%); +4 = 4/12 (33.3%). Conclusions: This is the largest single centre cohort study on the natural history of ASUC. A quarter of all UC patients experience at least one episode of ASUC. A third come to colectomy on the first admission, but half of those who have two or more admissions come to colectomy. When there are two or more TWC in addition to a bloody stool frequency 6/day, the risk of colectomy is four fold-higher than when there is only one additional TW criterion on admission.