EARLY PREDICTORS OF GLUCOCORTICOSTEROID TREATMENT FAILURE IN SEVERE AND MODERATELY SEVERE ATTACKS OF ULCERATIVE-COLITIS

Objective To analyse the ability of simple clinical and biochemical pa rameters to predict glucocorticosteroid (GCS) treatment failure in pat ients with acute attacks of ulcerative colitis. Design/methods Retrosp ective analysis of clinical and biochemical data. Setting Four Swedish university hospitals. Patients Ninety seven patients with acute attac ks of ulcerative colitis severe enough to warrant treatment with intra venous GCS, hospitalized during the years 1988-93. Main outcome measur e Colectomy within the first 30 days after hospitalization, defined as 'clinical steroid resistance'. Results Thirty days after admission, 3 9 patients (40%) were in complete clinical and endoscopic remission wh ile 33 (34%) had undergone colectomy. During follow-up for 24 months, four patients among the 39 initially in remission underwent colectomy. Among the 25 patients (26%) not attaining remission after 30 days, an additional nine patients subsequently required colectomy. Steroid res istance was associated with duration of disease (2.7 vs 8.1 years, P = 0.0037) and steroid treatment before hospitalization (70 vs 42%, P = 0.010). In particular, elevation of body temperature (37.4 vs 36.9 deg rees C, P = 0.012), persistence of diarrhoea (6.8 vs 3.6 bowel movemen ts/day, P< 0.0001) and passage of blood (83 vs 42%, P = 0.0003) as wel l as CRP elevation (36.3 vs 18.0 mg/l, P = 0.007) on day 3 after treat ment initiation were identified as predictors of a poor response. CRP greater than or equal to 25 mg/l and >4 bowel movements/day on day 3 o f hospitalization independently predicted a high risk for colectomy wi thin 30 days. Conclusions Sustained elevation of body temperature, per sistent bloody diarrhoea and continued CRP elevation on day 3 of intra venous GCS treatment strongly predict clinical steroid resistance in a cute attacks of ulcerative colitis. In the group of poor or non-respon ders, colectomy or more aggressive medical treatment should be conside red at an early stage. fur J Gastroenterol Hepatol 10:831-835 (C) 1998 Lippincott Williams & Wilkins.