Ulcerative colitis: clinical findings indicated which patients required colectomy in acute severe disease.
Clinical bottom line (level 2a)
A third of patients with acute severe ulcerative colitis required colectomy during their admission.
Patients with more than eight bowel actions and a CRP > 45 on day three of their admission, were very likely to require colectomy.
Patients without these risk factors were much less likely to require colectomy.
Travis et al:
Prospective cohort study
for confounding factors,
validated in an independent set of patients.
Setting: university hospital, UK
range 21 to 77 years; median 43,
admitted with 51 episodes of acute severe ulcerative colitis (Truelove and Witts criteria)
positive clinical prediction rule
All patients had intravenous and rectal hydrocortisone and 27% intravenous cyclosporine
Multivariate analysis was performed on the risk factors.
- 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
||time to outcome
||number of patients/total number
|prognostic factor for
|time to outcome
| positive clinical prediction rule
- 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.
- The clinical prediction rule needs to be validated in another set of patients.
reference from review article
C, et al:
Predicting outcome in severe ulcerative colitis.
Contributor: Chris Ball and Clare Wotton,
|Intervention or Exposure
||clinical prediction rule