Subhaharan D, Ramaswamy PK, Willmann L, Moattar H, Bhullar M, Ishaq N, Dorrington A, Shukla D, McIvor C, Edwards J, Mohsen W. Older adults with acute severe ulcerative colitis have similar steroid non-response and colectomy rates as younger adults. World J Gastroenterol 2023; 29(16): 2469-2478 [PMID: 37179589 DOI: 10.3748/wjg.v29.i16.2469]
Corresponding Author of This Article
Deloshaan Subhaharan, MD, Doctor, Department of Digestive Diseases, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast 4215, Queensland, Australia. deloshaan.subhaharan@health.qld.gov.au
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 28, 2023; 29(16): 2469-2478 Published online Apr 28, 2023. doi: 10.3748/wjg.v29.i16.2469
Older adults with acute severe ulcerative colitis have similar steroid non-response and colectomy rates as younger adults
Deloshaan Subhaharan, Pradeep Kakkadasam Ramaswamy, Laura Willmann, Hadi Moattar, Maneesha Bhullar, Naveed Ishaq, Alexander Dorrington, Dheeraj Shukla, Carolyn McIvor, John Edwards, Waled Mohsen
Deloshaan Subhaharan, Pradeep Kakkadasam Ramaswamy, Laura Willmann, Hadi Moattar, Maneesha Bhullar, Naveed Ishaq, Alexander Dorrington, Dheeraj Shukla, John Edwards, Waled Mohsen, Department of Digestive Diseases, Gold Coast University Hospital, Gold Coast 4215, Queensland, Australia
Carolyn McIvor, Department of Gastroenterology, Logan Hospital, Logan 4131, Queensland, Australia
Author contributions: Subhaharan D, Ramaswamy PK and Mohsen W designed the study and performed data analysis; Subhaharan D, Ramaswamy PK, Willmann L, Moattar H, Bhullar M, Ishaq N, Dorrington A, Shukla D, McIvor C, Edwards J, and Mohsen W performed literature review and manuscript writing; and all authors have read and approve the final manuscript.
Institutional review board statement: The study was approved by the Gold Coast Health Service Human Research Ethics Committee (Ref: LNR/2020/QGC/67173).
Informed consent statement: Due to the retrospective design of the study, the requirement for informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deloshaan Subhaharan, MD, Doctor, Department of Digestive Diseases, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast 4215, Queensland, Australia. deloshaan.subhaharan@health.qld.gov.au
Received: November 15, 2022 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
Abstract
BACKGROUND
There is paucity of data on outcomes of acute severe ulcerative colitis (ASUC) in older adults (≥ 60 years of age).
AIM
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
