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P156 Long-term outcomes of steroid-responsive and non-responsive patients with acute severe ulcerative colitis

S. Bernardo*1, S. Fernandes1, J. Estorninho2, J. Cortez Pinto3, I. Mocanu4, J. Sabino4, I. Rosa3, F. Portela2, L. Correia1

1Hospital Santa Maria, CHLN, Gastrenterology, Lisbon, Portugal, 2Centro Hospitalar Universitário de Coimbra, Gastrenterology, Coimbra, Portugal, 3Instituto Português de Oncologia Francisco Gentil, Lisboa, Gastrenterology, Lisbon, Portugal, 4Hospital Garcia de Orta, Almada, Gastrenterology, Almada, Portugal

Background

Up to one-third of patients with acute severe ulcerative colitis (ASUC) will fail intravenous steroid (IVS) treatment, requiring rescue therapy with cyclosporin (Cys), infliximab (IFX), or colectomy. Even with the best available therapy, over 1/3 of these patients will still require surgery. Long-term outcomes of steroid-responsive (SR) patients have seldom been studied. We hypothesise that this subgroup of patients also presents an unfavourable short- and long-term prognosis.

Methods

Retrospective multi-centre study including patients fulfilling Truelove and Witts criteria for ASUC. Response to IVS was determined by the attending physician between the third and fifth day of admission. Patients were then classified as steroid non-responders (SNR) or SR. A cohort of consecutive patients admitted with a flare of ulcerative colitis but without criteria for ASUC served as a control group (CG). Endpoints included the need for biologics, surgery or both in the 5 years following discharge.

Results

A total of 253 patients were included, 170 (67.2%) with ASUC (SNR: 47, SR: 123) and 83 controls. 53.4% were male with median age of 33 (18–80). Although SR patients presented lower surgical rates than SNR patients (13.9% vs. 53.2%, p < 0.001) they were substantially higher than in the CG (0%, p < 0.001). Of note, 70.6% of surgeries in SR patients occurred within 1 year after discharge. Furthermore, 40.6% of SR patients were subsequently readmitted with a flare of colitis requiring biologics or surgery in 44.0% and 28.0% of cases, respectively. Concerning treatment escalation, SR patients required less biologic therapy than SNR (36.7% vs. 91.5%, p < 0.001) but more so than patients in the CG (18.1%, p < 0.001). Likewise, a composite endpoint of any unfavourable outcome was more common in SR patients than in the CG (44.9% vs. 18.1%, p < 0.001). Time to event analysis showed that SR patients reached an unfavourable outcome sooner than the CG (log-rank test p < 0.001).

Conclusion

Patients with ASUC present an unfavourable prognosis, even after an adequate response to IVS. Early therapy intensification should strongly be considered in these patients as almost half develop unfavourable outcomes.