Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2469
Peer-review started: November 15, 2022
First decision: February 2, 2023
Revised: February 11, 2023
Accepted: March 24, 2023
Article in press: March 24, 2023
Published online: April 28, 2023
Processing time: 160 Days and 10.6 Hours
There is paucity of data on outcomes of acute severe ulcerative colitis (ASUC) in older adults (≥ 60 years of age).
To assess steroid non-response rates during the index admission for ASUC in older adults. Secondary outcomes were response to medical rescue therapy and colectomy rates; at index admission, 3 and 12 mo.
This retrospective multicentre cohort study included ASUC admissions who received intravenous steroids between January 2013 and July 2020 at two tertiary hospitals. Electronic medical records were reviewed to collect clinical, biochemical, and endoscopic data. A modified Poisson regression model was used for analysis.
Of 226 ASUC episodes, 45 (19.9%) occurred in patients ≥ 60 years of age. Steroid non-response rates were comparable in older adults and patients < 60 years of age [19 (42.2%) vs 85 (47%), P = 0.618, crude risk ratio (RR) = 0.89 [95% confidence interval (CI): 0.61-1.30], adjusted RR = 0.99 (0.44-2.21). Rates of response to medical rescue therapy in older adults was comparable to the younger cohort [76.5% vs 85.7%, P = 0.46, crude RR = 0.89 (0.67-1.17)]. Index admission colectomy [13.3% vs 10.5%, P = 0.598, crude RR = 1.27 (0.53-2.99), adjusted RR = 1.43 (0.34-6.06)], colectomy at 3 mo [20% vs 16.6%, P = 0.66, crude RR = 1.18 (0.61-2.3), adjusted RR = 1.31 (0.32-0.53)] and colectomy at 12 mo [20% vs 23.2%, P = 0.682, crude RR = 0.85 (0.45-1.57), adjusted RR = 1.21 (0.29-4.97)], were similar between the two groups.
In older adults with ASUC, the steroid non-response rate, response to medical rescue therapy, and colectomy rate at index admission, 3 and 12 mo is similar to patients less than 60 years of age.
Core Tip: This is a retrospective study to assess the outcomes of older adults (≥ 60 years of age) hospitalised with acute severe ulcerative colitis (ASUC) as per Truelove and Witts’ criteria. We identified 45 episodes of ASUC in older adults and compared outcomes with 181 episodes of ASUC in patients < 60 years of age. Older adults with ASUC have similar steroid non-response rate, response to medical rescue therapy and colectomy rates up to 12 mo from index admission, when compared to patients less than 60 years of age.