A Clinical Predictive Model for One-year Colectomy in Adults Hospitalized for Severe Ulcerative Colitis

Predictive factors for colectomy in severe ulcerative colitis include: prior biologic exposure, need for inpatient salvage therapy and younger age. Background Models to predict colectomy in ulcerative colitis (UC) are valuable for identification, clinical management, and follow-up of high-risk patients. Our aim was to develop a clinical predictive model based on admission data for one-year colectomy in adults hospitalized for severe UC. Methods We performed a retrospective analysis of patients hospitalized at a tertiary academic center for management of severe UC from 1/2013 to 4/2018. Multivariate regression was performed to identify individual predictors of one-year colectomy. Outcome probabilities of colectomy based on the prognostic score were estimated using a bootstrapping technique. Results Two hundred twenty-nine individuals were included in the final analytic cohort. Four independent variables were associated with one-year colectomy which were incorporated into a point scoring system: (+) 1 for single class biologic exposure prior to admission; (+) 2 for multiple classes of biologic exposure; (+) 1 for inpatient salvage therapy with cyclosporine or a TNF-alpha inhibitor; (+) 1 for age <40. The risk probabilities of colectomy within one year in patients assigned scores 1, 2, 3, and 4 were 9.4% (95% CI, 1.7-17.2), 33.7% (95% CI, 23.9-43.5), 58.5% (95% CI, 42.9-74.1), 75.0% (95% CI, 50.5-99.5). An assigned score of zero was a perfect predictor of no colectomy. Conclusion Risk factors most associated with one-year colectomy for severe UC included: prior biologic exposure, need for inpatient salvage therapy, and younger age. We developed a simple scoring system using these variables to identify and stratify patients during their index hospitalization. Lay Summary The one year risk of colectomy in patients hospitalized with ulcerative colitis increases if they are younger than 40-years-old, have used one or more biologic drugs in the past and/or receive an inpatient salvage (step-up) therapy during the hospitalization.

Automated summary

The predictive factors for colectomy in severe ulcerative colitis include prior biologic exposure, need for inpatient salvage therapy, and younger age. A clinical predictive model based on admission data was developed to identify high-risk patients for one-year colectomy in adults hospitalized for severe UC.