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REVIEW OF MEDICAL RESCUE THERPAIES IN PATIENTS WITH SEVERE ACUTE ULCERATIVE COLITIS REQUIRING HOSPITAL ADMISSION
A Weizman1, A Steinhart2 1Division of Gastroenterology, Department of Medicine, University of Toronto; 2Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital/University Health Network, Toronto, Ontario
AIMS: Data evaluating the relative merits of medical rescue therapy with either infliximab or cyclosporine in patients presenting with acute, severe ulcerative colitis (UC) requiring hospital admission is limited. The objective of this study was to review the outcome of patients admitted to a tertiary care centre with a severe flare of UC in order to characterize patient outcomes following medical rescue therapies as compared to those who did not receive rescue therapy.
METHODS: A retrospective chart review of all patients admitted with a diagnosis of UC flare to Mount Sinai Hospital in Toronto, Canada between 2000 and 2007 was performed. Patients with Crohn's disease, indeterminate colitis, and admissions of less than 24 hours were excluded. Primary outcomes evaluated included colectomy during admission and colectomy or readmission for UC flare within thirty days of discharge.
Data was analyzed using 2×2 contingency tables and Fisher's exact test. P-values<.05 were considered statistically significant.
RESULTS: 107 patients met inclusion criteria and underwent chart review. Twenty five patients received infliximab in hospital, of whom 3 (12%) underwent colectomy that admission and none of the remaining patients were readmitted or underwent colectomy within 30 days of discharge. There were 2 patients who received cyclosporine during admission, one undergoing colectomy that admission and the other two years later. Seventy nine patients received corticosteroids alone, of whom 16 (20%) underwent colectomy during that admission. Among the remaining 63 patients, 10 (13%) were readmitted within 30 days of discharge and 5 (6%) underwent colectomy within 30days of discharge. Three of the 25 (12%) patients who received infliximab experienced a primary end point compared to 26 of the 79 (33%) patients who received corticosteroids alone (p=.04).
CONCLUSIONS: Patients who were treated with infliximab in hospital had low colectomy rates during admission and within 30 days of discharge as well as low readmission rates within 30 days of discharge. There is a need for prospective long-term studies on outcomes for hospitalized patients with severe, acute UC treated with infliximab.