Características clínicas y desenlaces en pacientes hospitalizados por brotes severos de colitis ulcerosa

Experiencia de cuatro años

Abstract

Objectives: To describe population characteristics in a case series of acute severe ulcerative colitis (ASUC) and to identify factors associated with steroid-refractoriness and/or complications.

Materials and methods: Retrospective, observational, descriptive and comparative study of ASUC episodes hospitalized at Lagomaggiore Hospital, Mendoza, between 2021 and 2025. ASUC was defined according to Truelove and Witts criteria.

Results: Eighteen ASUC cases, 11 female (61%), age 35.89±13.83 years. Previous corticosteroid exposure 11 (61.1%). Most frequent comorbidities: former tobacco exposure 7 (38.9%), current 1 (5.6%), malnutrition/underweight 4 (22.2%), overweight/obesity 3 (16.7%), and psoriasis 1 (5.56%). Laboratory: Median Hb 10 g/dL (IQR 8.0–12.8), C-reactive protein (CRP) 65.1 mg/L (IQR 18.6–144), Albumin 31 g/L (IQR 27–35), ESR 34 mm/h (IQR 25–58.2). CRP on day 3 ≥45 mg/L 3 (16.7%), observed exclusively in steroid-refractory patients. Endoscopic extent: pancolitis 11 (61.1%), left-sided 6 (33.3%), unspecified 1 (5.6%). Complications: megacolon 2 (11.1%), colectomy 2 (11.1%), mortality 1 (5.6%), all of them with pancolitis. Steroid-refractoriness: 8 (44.4%), CMV infection: 5 (27.8%), Clostridium difficile infection: 4 (22.2%). When comparing steroid-refractory patients 8 (44.4%) vs non-refractory 10 (55.6%), CMV infection was observed in 4 (50%) vs 1 (10%) p 0.12, CRP on day 3 ≥45 mg/L 3 (37.5%) vs 0 (0%) p 0.09, CRP/albumin ratio (CAR) on day 1 ≥0.6: 8 (100%) vs 4 (40%) p 0.013, and CAR on day 3 ≥0.85: 6 (75%) vs 2 (20%) p 0.054.

Conclusions: In our ASUC sample, women with low body weight and prior corticosteroid exposure predominated. A significant association was observed between steroid-refractoriness and CAR ≥0.6 at admission. Furthermore, a trend toward increased steroid-refractoriness was identified in patients with CMV infection, CRP ≥45 mg/L on day 3, and CAR ≥0.85 on day 3.