Prognosis

• ≥ 6 bowel motions on the day of admission ^b
• > 8 bowel actions and a CRP > 45 on the third day of admission ^b
• fever ≥ 38°C or pulse ≥ 90 on any day ^b
• serum albumin level ≤ 35 g/l ^b
• pancolitis or small bowel distention on abdominal X-ray ^c
• severe endoscopic colitis ^c
  • extensive deep ulcerations or well-like ulcerations
  • mucosal detachment on the edge of these ulcerations
  • large mucosal abrasions

Why?

Continued frequent diarrhoea and a raised CRP increase the risk of colectomy

Patient	Prognostic Factor	Outcome	CER	RR (95% CI)	NNF+ (95% CI)
acute ulcerative colitis b	> 8 bowel actions and a CRP > 45 on day 3 of admission not independent	colectomy at discharge	8.5%	8.75 (2.86 to 26.8)	2 (1 to 6)

 

Small bowel distension and pancolitis on abdominal X-ray increase the risk of colectomy

Outcome	Risk Factor	PEER	OR (95% CI)	NNH (95% CI)
colectomy c	small bowel distension not independent	30%	3.56 (1.33 to 9.47)	3 (2 to 16)
	pancolitis not independent	30%	6.38 (2.12 to 19.2)	2 (2 to 6)

Severe colitis on endoscopy increases the risk of colectomy

Patient	Prognostic Factor	Outcome	CER	RR (95% CI)	NNF+ (95% CI)
acute colitis c	severe colitis on endoscopy not independent	surgery at discharge	23%	4.05 (2.27 to 7.22)	1 (1 to 3)