Predictive factors of outcome of intensive intravenous treatment for attacks of ulcerative colitis

Background: Intensive intravenous treatment remains the first line therapy of severe, uncomplicated attacks of ulcerative colitis. Aim: To predict the failure of intensive intravenous treatment by combining clinical and laboratory parameters with endoscopy findings. Methods: Retrospective study conducted in a tertiary care referral centre. Failure of intensive intravenous treatment was defined as colectomy before day 30, intravenous cyclosporin, or death. Predictive factors of outcome we re assessed using univariate and multivariate prognostic analysis. Results: Between January 1990 and May 1997, 85 consecutive patients were tr eated with intensive intravenous treatment for non-response to oral cortico steroids (n = 59) and/or severe attack of ulcerative colitis (n = 26). Ther e were 41 successes and 44 failures (including 1 death, 13 cyclosporin and 30 colectomies before day 30). Multivariate prognostic analysis found that the presence of Truelove and Witts' criteria (P = 0.018), an attack that ha d lasted more than 6 weeks (P = 0.001), and severe endoscopic lesions (P = 0.007) were associated with an increased risk of failure. Patients with sev ere endoscopic lesions and Truelove and Witts' criteria, or an attack of mo re than 6 weeks had a failure rate of 85-86%. Conclusion: Clinical, laboratory and endoscopic findings can predict the ri sk of failure of intensive intravenous treatment. A prospective study is re quired to confirm these results.