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P464 Short- and Long-term Outcomes of Acute Severe Ulcerative Colitis in Korea: The 1999-2005 cohort

H.-S. Lee1, S.-K. Yang1, K. Chang2, H. Seo*1, H. So1, J.S. Soh2, S. Lee2, J.H. Bae1, H.J. Lee2, S.H. Park1, D.-H. Yang2, K.-J. Kim1, B.D. Ye2, J.-S. Byeon1, S.-J. Myung1

1University of Ulsan Collage of Medicine, Asan Medical Center , Gastroenterology, Seoul, Korea, Republic of, 2University of Ulsan Collage of Medicine, Asan Medical Center, Gastroenterology, Seoul, Korea, Republic of

Background

No studies have evaluated the long-term outcomes of acute severe ulcerative colitis (ASUC) in non-Caucasian populations. The purposes of this study were to evaluate short- and long-term outcomes of Korean patients with ASUC.

Methods

We retrospectively analyzed 99 patients with ASUC who satisfied the Truelove and Witts' criteria between 1999 and 2005. The short-term outcome parameter was colectomy rates during the index hospitalization, and the long-term outcome parameters were rates of colectomy and re-hospialization after discharge from the index hospitalization.

Results

During the index hospitalization, 16 of 99 patients (16.2%) underwent colectomy: 6 of 71 responders (8.5%) to intravenous steroids on day 3 versus 10 of 28 non-responders (35.7%) assessed using the Oxford Index (odds ratio, 6.02; 95% confidence interval, 1.93-18.80; P = 0.002). Among 83 patients who avoided colectomy during the index hospitalization, 13 patients (15.7%) underwent colectomy during a median duration of follow-up of 10.5 years (range, 0.3-15.4 years), producing cumulative probabilities of colectomy at 1, 5, 10, and 15 years after discharge of 2.4%, 10.1%, 14.3%, and 23.0%, respectively. In addition, 34 patients (40.1%) experienced a re-hospitalization for UC during follow-up with 1- 5- 10- and 15-year cumulative probabilities of 12.2%, 31.2%, 41.9%, and 48.6%, respectively. The cumulative probability of colectomy tended to be lower in complete responders on day 7 of intravenous steroid therapy than in the others: 3.7% versus 13.9% at 5 years, and 7.6% versus 18.2% at 10 years (P = 0.100). The cumulative probability of re-hospitalization was significantly lower in complete responders on day 7 of intravenous steroid therapy than in the others: 20.5% versus 37.5% at 5 years, and 31.4% versus 48.2% at 10 years (P = 0.043).

Conclusion

Assessment of the degree of response to intravenous steroids is helpful in predicting short- and long-term outcomes of ASUC. Korean patients with ASUC may have better short-term and long-term prognoses than Westerners, as indicated by the lower colectomy rate.

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120176).