Clinical features, prognostic factors, and treatment response in severe acute colitis
DOI:
https://doi.org/10.47456/rbps.v26i1.51180Keywords:
Colitis, Gastroenterology, Ulcerative Colitis, Crohn's Disease, Clinical EpidemiologyAbstract
Introduction: Severe acute colitis is an important complication of inflammatory bowel disease and an emergency in Gastroenterology. Objective: To analyze a case series of severe acute colitis patients admitted to a tertiary hospital in 2023 and 2024. Methods: A retrospective study of the epidemiological characteristics, prognostic factors, therapeutic response, and clinical outcomes of 12 patients with severe acute colitis. Results: Mean age was 44.5 years (±18.9); average hospitalization time was 17 days; 7 female patients; 5 with Crohn's disease and 7 with ulcerative colitis; fulminant colitis occurred in 2 cases. Mean albumin was 3 g/mL, with 6 patients having albumin ≤ 2.9 g/mL and 6 patients having albumin > 3.0 g/mL. Younger patients had lower albumin levels, but this difference was not statistically significant (p=0.08). The mean initial C-reactive protein (CRP) was 93.4 mg/L and was higher in patients with deep ulcers (p=0.03); after 3 days of corticosteroid treatment, the mean CRP was 35.5 mg/L. Seven patients did not respond to corticosteroids and received rescue therapy: 4 with infliximab (all responded) and 3 with tofacitinib (only 1 responded). Three patients tested positive for Clostridioides difficile; there were no cytomegalovirus infections, and 3 patients developed deep vein thrombosis. Colectomy was performed in 3 patients (2 who were refractory to corticosteroid treatment and rescue therapy, and 1 who had toxic megacolon). Conclusions: Management of severe acute colitis represents a challenge in clinical practice. Recognizing prognostic factors, criteria for treatment failure with corticosteroids, options for rescue therapies, as well as the timing and indications for surgery, are crucial for clinical outcomes.
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