D0392 - Predictors of Colectomy in Acute Severe Ulcerative Colitis

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Shreyak Sharma, MBBS

Yale University School of Medicine
New Haven, CT

Shreyak Sharma, MBBS, Darrick K. Li, MD, PhD, Louis J. Levine, MD, MEd, Abdelkader Chaar, MD, Chandler McMillan, BA, Jill K. Gaidos, MD, Deborah Proctor, MD, Badr Al-Bawardy, MD
Yale University School of Medicine, New Haven, CT

Introduction: Up to 30% of patients admitted with acute severe ulcerative colitis (UC) will require a colectomy despite advances in medical therapies. Our aim was to assess the risk factors for colectomy in patients hospitalized with acute severe ulcerative colitis using initial admission data.

Methods: This is a single-center, retrospective study of all patients hospitalized with acute severe UC from 1/1/2012-11/1/2021. Patients who underwent colectomy (during the admission or after discharge) were compared with patients who did not have a colectomy. Continuous variables were analyzed using an unpaired student’s t-test. Categorical variables were analyzed using a Pearson’s chi-square test. Variables with p< 0.05 on univariate analysis were identified and incorporated as independent variables in a multivariate regression model.

Results: A total of 168 patients hospitalized with acute severe UC were included (52.4% were male; mean age was 39.8 ±17.2 years). The median disease duration was 2.5 years (IQR 1-10) and 64.9% (n=109) of the cohort were biologic naïve. A total of 31 patients (18.5%) required a colectomy. On univariate analysis, the following factors were associated with a higher risk of colectomy: female sex (70.9% vs 42.3%, p=0.004), lower hemoglobin (10.5 vs 12 g/dL, p=0.002), lower albumin level (3.2 vs 3.5 g/dL, p=0.015). Patients who were on oral corticosteroids on admission had a higher risk of colectomy (70.9% vs 48.9%, p=0.02) while patients who were biologic naïve had a lower risk of colectomy (41.9% vs 70.1%, p=0.003). C-reactive protein level on admission was not associated with risk of colectomy (Table 1). A multivariate logistic regression model comprising the above variables showed that female sex (p=0.019) and lower hemoglobin (p=0.048) were independently associated with an increased risk of colectomy.

Discussion: In our cohort, approximately one fifth of patients with acute severe UC required a colectomy. Female sex and lower hemoglobin on admission were independently associated with a higher risk of colectomy while biologic naïve patients had a lower risk of colecomy. Further studies to assess if earlier treatment could further lower colectomy rates are needed.

Table 1. Baseline Characteristics
*Variables*	*Colectomy (n=31)*	*No colectomy (n=137)*	*p-value*
*Patient characteristics*
Age, mean (SD)	40.5 (19.7)	39.6 (16.7)	0.82
Female, n (%)	22 (70.9)	58 (42.3)	0.004
*Disease activity*
Pancolitis, n (%)	20 (64.5)	97 (70.8)	0.75
Disease duration in years, mean (SD)	6.3 (7.9)	6.9 (9.4)	0.71
Presence of extraintestinal manifestations, n (%)	1 (3.2)	12 (8.8)	0.29
Smoking, n (%)	2 (6.5)	7 (5.1)	0.58
Concomitant CMV infection, n (%)	2 (6.5)	1 (0.7)	0.08
Concomitant C. difficile infection, n (%)	1 (3.2)	8 (5.8)	0.56
*Labs at presentation*
Hemoglobin g/dL, mean (SD)	10.5 (2.2)	12.0 (2.6)	0.002
C-reactive protein md/dL, mean (SD)	85.7 (61.2)	80.4 (84.9)	0.73
Albumin g/dL, mean (SD)	3.2 (0.7)	3.5 (0.6)	0.015
*Medications*
Biologic naïve, n (%)	13 (41.9)	96 (70.1)	0.003
Inpatient infliximab rescue, n (%)	16 (51.6)	51 (37.2)	0.14
On oral corticosteroid at time of admission, n (%)	22 (70.9)	67 (48.9)	0.026
Statins on admission, n (%)	4 (12.9)	9 (6.6)	0.44
Chronic outpatient opioid use, n (%)	3 (9.7)	10 (7.3)	0.65
Inpatient opioid, n (%)	17 (54.8)	72 (52.6)	0.82
On IMM on admission, n (%)	1 (3.2)	13 (9.5)	0.25
SD: standard deviation; CMV: cytomegalovirus; C. difficile: Clostridiodes difficle; IMM: immunomodulator

Table: Baseline characteristics

Disclosures:

Shreyak Sharma indicated no relevant financial relationships.

Darrick Li indicated no relevant financial relationships.

Louis Levine indicated no relevant financial relationships.

Abdelkader Chaar indicated no relevant financial relationships.

Chandler McMillan indicated no relevant financial relationships.

Jill Gaidos: AbbVie – Speakers Bureau.

Deborah Proctor: AbbVie – Consultant, Grant/Research Support. Celgene – Grant/Research Support. Parexel – Grant/Research Support.

Badr Al-Bawardy: AbbVie – Speakers Bureau. Bristol Myers Squibb – Advisor or Review Panel Member. Takeda – Speakers Bureau.

Shreyak Sharma, MBBS, Darrick K. Li, MD, PhD, Louis J. Levine, MD, MEd, Abdelkader Chaar, MD, Chandler McMillan, BA, Jill K. Gaidos, MD, Deborah Proctor, MD, Badr Al-Bawardy, MD. D0392 - Predictors of Colectomy in Acute Severe Ulcerative Colitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.