Ulcerative colitis: clinical findings indicated which patients required colectomy in acute severe disease.

Clinical bottom line (level 2a)

  1. A third of patients with acute severe ulcerative colitis required colectomy during their admission.
  2. Patients with more than eight bowel actions and a CRP > 45 on day three of their admission, were very likely to require colectomy.
  3. Patients without these risk factors were much less likely to require colectomy.
Travis et al: Gut 1996; 38: 905-910
Expires May 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, UK

49 patients (aged range 21 to 77 years; median 43, 53% male) admitted with 51 episodes of acute severe ulcerative colitis (Truelove and Witts criteria)

Factors studied:
  • colectomy
  • positive clinical prediction rule


    • All patients had intravenous and rectal hydrocortisone and 27% intravenous cyclosporine

    Multivariate analysis was performed on the risk factors.

    100% followed for 12 months
    Outcomes studied:
  • colectomy

    • The study was the development of a clinical prediction rule.
    • Risk factors: clinical findings, laboratory results on first five days of admission
    • Best combination of risk factors was on day 3 of admission:
      • more than eight bowel actions and CRP >45 mg/dl

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    colectomy 12 months 15/51 29%
    (17% to 42%)

    prognostic factor for
    colectomy     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    positive clinical prediction rule 12 months 8.75
    (2.86 to 26.8)     		2
    (1 to 6)

    Comments

    1. All patients who were classified as requiring colectomy by the clinical prediction rule but did not during their admission, subsequently had a colectomy in the following months.
    2. The clinical prediction rule needs to be validated in another set of patients.

    Citation

    1. Travis SP, Farrant JM, Ricketts C, et al: Predicting outcome in severe ulcerative colitis. Gut 1996; 38: 905-910
    Search Terms: reference from review article
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient ulcerative colitis
    Intervention or Exposure clinical prediction rule
    Outcome requiring colectomy