Clinical outcomes and predictive factors in oral corticosteroid-refractory active ulcerative colitis

Table 1 Baseline characteristics of patients with active ulcerative colitis receiving intravenous corticosteroids after oral corticosteroid therapy failure

	Total patients (n = 67)
Gender (male/female)	39/28 (58.2/41.8)
Age (yr)	35 (13-78)
Age at diagnosis (yr)	31 (11-78)
Disease duration (mo)	24 (0-132)
Disease extent
Proctitis	5 (7.5)
Left-sided colitis	21 (31.3)
Extensive colitis	41 (61.2)
First attack of UC	32 (47.8)
Number of previous flares	2 (1-4)
Initial disease activity
Full Mayo score	9 (5-10)
Partial Mayo score	6 (3-7)
Initial prednisolone dose (mg)
≥ 30 and < 40	35 (52.2)
≥ 40	32 (47.8)
Duration of oral corticosteroid use (d)	13 (3-50)
Maintenance before flare up
None/salicylates/azathioprine	6/47/14
Concomitant medications
Salicylates	53
Azathioprine	14
CRP (mg/dL)	10.9 (0.1-153.0)
ESR (mm/h)	40.0 (3.0-120.0)
Hemoglobin (mg/dL)	11.7 (6.4-16.5)
Albumin (mg/dL)	3.6 (2.3-5.0)

Data are expressed as absolute numbers (percentage) or median. UC: Ulcerative colitis; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate.

Table 2 Comparison of clinical factors in immediate outcomes of the two groups of active ulcerative colitis patients receiving intravenous corticosteroids after oral corticosteroid therapy failure

	Responders (n = 56)	Non-responders1 (n = 11)	P-value		Odds ratio (95%CI)
			Univariate	Multivariate
Gender (M/F)	32/24 (57.1/42.9)	7/4 (63.6/36.4)	0.690
Age (yr)	37 (13-78)	39 (29-50)	0.458
Disease duration (mo)
≤ 24	34 (60.7)	3 (27.3)	0.041	0.123	3.38 (0.72-15.88)
> 24	22 (39.3)	8 (72.7)
First attack of UC	26 (46.4)	6 (54.5)	0.273
Disease extent			0.884
Proctitis	4 (7.1)	1 (9.1)
Left-sided colitis	17 (30.4)	4 (36.4)
Extensive colitis	35 (62.5)	6 (54.5)
Disease activity
Full Mayo score (< 9/≥ 9)	27/24 (52.9/47.1)	3/8 (27.3/72.7)	0.122
Partial Mayo score (< 6/≥ 6)	14/42 (25/75)	1/10 (9.1/90.9)	0.227
Initial prednisolone dose (mg)			0.622
≥ 30 and < 40	29 (51.8)	6 (54.5)
≥ 40	27 (48.2)	5 (45.5)
Duration of oral corticosteroid use (d)
≤ 14	33 (58.9)	3 (27.3)	0.054	0.049	4.9 (1.01-23.81)
> 14	23 (41.1)	8 (72.7)
Concomitant medications			0.809
Salicylates	44 (78.6)	9 (81.8)
Azathioprine	12 (21.4)	2 (18.2)
CRP (mg/dL)
≤ 8	37 (66.1)	11 (84.6)	0.303
> 8	19 (33.9)	2 (15.4)
ESR (mm/h)	40 (3-120)	40 (12-83)	0.999
Hemoglobin (mg/dL)
≤ 11	18 (32.1)	8 (72.7)	0.012	0.02	0.16 (0.03-0.75)
> 11	38 (67.9)	3 (27.3)
Albumin (mg/dL)	3.63 (2.3-5.0)	3.56 (2.8-4.8)	0.331

¹Non-responder group included patients that had secondary alternative drug use, proctocolectomy and death before day 14. M/F: Male/female; UC: Ulcerative colitis; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate.

Table 3 Comparison of clinical factors in one month outcomes of the two groups of active ulcerative colitis patients receiving intravenous corticosteroids after oral corticosteroid therapy failure

	Good responders1(n = 44)	Poor responders2(n = 12)	P-value univariate
Gender (M/F)	24/20 (54.5/45.5)	8/4 (66.7/33.3)	0.956
Age (yr)	37 (11-78)	38 (29-59)	0.342
Disease duration (mo)
≤ 24	25 (56.8)	9 (75)	0.253
> 24	19 (43.2)	3 (3)
First attack of UC	18 (40.9)	8 (66.7)	0.113
Disease extent			0.943
Proctitis	3 (6.8)	1 (8.3)
Left-sided colitis	13 (29.5)	4 (33.3)
Extensive colitis	28 (63.6)	7 (58.3)
Disease activity
Full Mayo score (< 9/≥ 9)	23/19 (54.8/45.2)	4/5 (44.4/55.6)	0.574
Partial Mayo score (< 6/≥ 6)	12/32 (27.3/72.7)	2/10 (16.7/83.3)	0.452
Initial prednisolone dose (mg)			0.429
≥ 30 and < 40	24 (54.5)	5 (41.7)
≥ 40	20 (45.5)	7 (58.3)
Duration of oral corticosteroid use (d)
≤ 14	26 (59.1)	7 (58.3)	0.962
> 14	18 (40.9)	5 (41.7)
Concomitant medications			0.212
Salicylates	33 (75)	11 (91.7)
Azathioprine	11 (25)	1 (8.3)
CRP (mg/dL)
≤ 8	28 (63.6)	9 (75)	0.461
> 8	16 (36.4)	3 (25)
ESR (mm/h)	40.7 (3-120)	37.2 (12-83)	0.464
Hemoglobin (mg/dL)
≤ 11	15 (34.1)	3 (25)	0.550
> 11	29 (65.9)	9 (75)
Albumin (mg/dL)	3.6 (2.3-5.0)	3.45 (2.6-4.8)	0.295

¹Good responders included patients with prolonged response that maintained complete remission or partial remission after completion of corticosteroid therapy;

²Poor responders included patients with steroid dependence and non-response. M/F: Male/female; UC: Ulcerative colitis; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate.

Table 4 Comparison of clinical factors in three month outcomes of the two groups of active ulcerative colitis patients receiving intravenous corticosteroids after oral corticosteroid therapy failure

	Good responders1(n = 37)	Poor responders2(n = 18)	P-value univariate
Gender (M/F)	21/16 (56.8/43.2)	10/8 (55.6/44.4)	0.933
Age (yr)	35 (13-78)	41 (20-62)	0.146
Disease duration (mo)
≤ 24	22 (59.5)	12 (66.7)	0.606
> 24	15 (40.5)	6 (33.3)
First attack of UC	15 (40.5)	10 (55.6)	0.294
Disease extent			0.317
Proctitis	3 (8.1)	1 (5.6)
Left-sided colitis	9 (24.3)	8 (44.4)
Extensive colitis	25 (67.6)	9 (50)
Disease activity
Full Mayo score (< 9/≥ 9)	20/14 (58.8/41.2)	7/9 (43.8/56.3)	0.318
Partial Mayo score (< 6/≥ 6)	11/26 (29.7/70.3)	3/15 (16.7/83.3)	0.297
Initial prednisolone dose (mg)			0.925
≥ 30 and < 40	19 (51.4)	9 (50)
≥ 40	18 (48.6)	9 (50)
Duration of oral corticosteroid use (d)			0.639
≤ 14	23 (62.2)	10 (55.6)
> 14	14 (37.8)	8 (44.4)
Concomitant medications			0.180
Salicylates	27 (73)	16 (88.9)
Azathioprine	10 (27)	2 (11.1)
CRP (mg/dL)
≤ 8	24 (64.9)	12 (66.7)	0.895
> 8	13 (35.1)	6 (33.3)
ESR (mm/h)	36.9 (3-120)	47.6 (6-120)	0.251
Hemoglobin (mg/dL)
≤ 11	14 (37.8)	4 (22.2)	0.247
> 11	23 (62.2)	14 (77.8)
Albumin (mg/dL)	3.73 (2.7-5.0)	3.44 (2.3-4.6)	0.082

¹Good responders included patients with prolonged response that maintained complete remission or partial remission after completion of corticosteroid therapy;

²Poor responders included patients with steroid dependence and non-response. M/F: Male/female; UC: Ulcerative colitis; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate.

Table 5 Comparison of clinical factors in one year outcomes of the two groups of active ulcerative colitis patients receiving intravenous corticosteroids after oral corticosteroid therapy failure

	Good responders1(n = 25)	Poor responders2(n = 29)	P-value univariate
Gender (M/F)	15/10 (60/40)	16/13 (55/45)	0.721
Age (yr)	35 (16-78)	39 (13-64)	0.445
Disease duration (mo)	30 (0-84)	29 (0-120)	0.325
≤ 24	14 (56)	20 (69)
> 24	11 (44)	9 (31)
First attack of UC	9 (36)	15 (51.7)	0.248
Disease extent			0.304
Proctitis	1 (4)	3 (10.3)
Left-sided colitis	6 (24)	11 (37.9)
Extensive colitis	18 (72)	15 (51.7)
Disease activity
Full Mayo score (< 9/≥ 9)	15/9 (62.5/37.5)	11/14 (44/56)	0.195
Partial Mayo score (< 6/≥ 6)	9/16 (36/64)	4/25 (13.8/86.2)	0.057
Initial prednisolone dose (mg)			0.785
≥ 30 and < 40	13 (52)	14 (48.3)
≥ 40	12 (48)	15 (51.7)
Duration of oral corticosteroid use (d)			0.337
≤ 14	17 (68)	16 (55.2)
> 14	8 (32)	13 (44.8)
Concomitant medications			0.771
Salicylates	19 (76)	23 (79.3)
Azathioprine	6 (24)	6 (20.7)
CRP (mg/dL)
≤ 8	16 (64%)	19 (65.5)	0.907
> 8	9 (36%)	10 (34.5)
ESR (mm/h)	34.1 (4-81)	46.3 (3-120)	0.171
Hemoglobin (mg/dL)
≤ 11	9 (36)	8 (27.6)	0.507
> 11	16 (64)	21 (72.4)
Albumin (mg/dL)	3.8 (2.7-4.7)	3.57 (2.3-5.0)	0.230

¹Good responders included patients with prolonged response that maintained complete remission or partial remission after corticosteroid therapy had finished;

²Poor responders included patients with steroid dependence and non-response. M/F: Male/female; UC: Ulcerative colitis; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate.