Multiple organ dysfunction in ulcerative colitis

OBJECTIVE: The mortality rate in severe ulcerative colitis (UC) is commonly attributed to major colonic complications or surgical procedures. Early re cognition of the severity of the colitis, intensive medical treatment, and prompt surgery have all contributed to improving its outcome over the past 40 yr. Recently, we have observed some fatal cases of severe UC in which de ath was related to multiple organ dysfunction syndrome (MODS). This complic ation, associated with a very high mortality rate, may occur in several acu te critical diseases, both infectious and noninfectious, but has so far not been reported in UC. The aim of this study was to evaluate the prevalence and outcome of MODS in severe UC. METHODS: The records of 180 consecutive patients admitted to the Gastrointe stinal Unit, University of Rome for an acute severe attack of UC during the period 1976-1998 were retrospectively analyzed. Severity of UC was defined according to the criteria of Truelove and Witts. MODS was defined accordin g to the original critiera of the American College of Chest Physicians/Soci ety of Critical Care Medicine Consensus Conference 1997. All patients were on a standard intensive regimen consisting of total parenteral nutrition an d hydrocortisone 100 mg q.i.d. Colectomy was performed according to the tim ing of the Oxford intensive regimen. RESULTS: Of these 180 severe UC patients, 11 (6.1%) experienced clinical an d laboratory features of MODS. The lung was involved in five patients, the kidney in three, the liver in seven, the central nervous system in three, t he hematological system in three, and the pancreas in one. MODS was precede d by toxic megacolon in five patients and by so-called "impending megacolon " in four, whereas in two patients no previous complications of UC were obs erved. MODS developed during the first attack of colitis in seven patients and during relapse in four. The overall mortality rate was 12/180 (6.6%). O f the 12 patients who died, eight (72.7%) had MODS. CONCLUSIONS: These data indicate that UC must be included among the causes of MODS. In our referral center for inflammatory bowel diseases, MODS was r esponsible for the majority of UC cases with a fatal outcome. The timely id entification of signs of MODS should prompt admission to an intensive care unit and emergency surgery. (C) 2000 by Am. Cell. of Gastroenterology.