P191. Risk factors for colectomy in ulcerative colitis patients with severe flare‑up
T. Molnár1, K. Farkas1, F. Nagy1, Z. Szepes1, T. Nyari2, T. Wittmann1
1University of Szeged, First Department of Medicine, Szeged, Hungary; 2University of Szeged, Department of Medical Informatics, Szeged, Hungary
Background: Hospitalization and corticosteroid use had recently been shown to increase the risk for colectomy in patients with acute ulcerative colitis (UC). Finding simple risk factors predisposing to surgery could help the clinicians to indicate surgical intervention at the appropriate time in patients with UC. The aim of the present study was to examine different laboratory and clinical data which may help to predispose colectomy in acute UC.
Methods: Using the database of our clinic, we evaluated every hospital admissions due to acute exacerbation of UC and requiring intravenous corticosteroid treatment between 1998 and 2009. Inflammatory laboratory parameters were assessed at every hospitalization of patients undergoing colectomy and in those who avoided surgery. Gender, disease duration, smoking habits, the extent of the disease, the number of hospitalizations, the body mass index (BMI), the presence of extraintestinal manifestations, the need for transfusion, transfer from another hospital and the frequency of Clostridium difficile infection were also compared and statistically analyzed between the two groups. P < 0.05 was considered statistically significant.
Results: The records of 182 UC patients with a total of 276 hospitalizations because of severe relapse of UC were reviewed. 25.3% of the patients underwent colectomy after average disease duration of 10 years. Pancolitis, low hematocrit level and the need for blood transfusion were significantly more common in the colectomy group (p = 0.004 and p = 0.002). The number of hospitalization, disease duration, and a lower BMI value also proved to predispose to surgery (p = 0.004, p = 0.049 and p = 0.027). Women, younger age at the diagnosis and thrombocytosis showed borderline significance in the risk for colectomy. No association was found between the need for surgery and total parenteral nutrition, Clostridium difficile infection, transfer from another hospital, and electrolyte disturbances. None of the inflammatory laboratory parameters were associated with colectomy. Smoking and the presence of extraintestinal manifestations also did not predispose to surgery.
Conclusions: Our results suggest that severe UC patients with pancolitis, anemia, longer disease duration and frequent hospital admissions have a higher likelihood of requiring colectomy.