Faculty Collaboration Database

History of medical hospitalization predicts future need for colectomy in patients with ulcerative colitis. Inflamm Bowel Dis 2009 Feb;15(2):176-81

Date

08/06/2008

Pubmed ID

18680197

DOI

10.1002/ibd.20639

Scopus ID

2-s2.0-67649703547 (requires institutional sign-in at Scopus site)   70 Citations

Abstract

BACKGROUND: Patients who require hospitalization for the management of ulcerative colitis (UC) may represent a subset with severe disease. These patients may be more likely to require future colectomy. There are limited data examining whether medical hospitalization is predictive of subsequent colectomy.

METHODS: This was a retrospective case-control study utilizing the inflammatory bowel disease center database at our academic referral center. Cases comprised UC patients who underwent colectomy for disease refractory to medical management. The control population was comprised of all patients with UC who had not undergone colectomy. Multivariate logistic regression was used to identify independent predictors of requiring colectomy.

RESULTS: There were a total of 246 UC patients included in our study, with 103 being hospitalized sometime in their disease course (41.9%). A total of 27 patients underwent colectomy (11%). Colectomy patients were significantly more likely to have been on infliximab therapy (51.8% versus 22.4%, P = 0.001) but no more likely to have been on immunomodulator therapy (74.1% versus 59.4%, P = 0.14). Patients who required medical hospitalization for UC were more likely to require future colectomy (20.4% versus 4.2%, P < 0.001) than those who had not required hospitalization. On multivariate analysis, requiring medical hospitalization for management of UC (odds ratio [OR] 5.37, 95% confidence interval [CI] 2.00-14.46) and ever requiring infliximab therapy (OR 3.12, 95% CI 1.21-8.07) were independent predictors of colectomy.

CONCLUSIONS: Requiring medical hospitalization for the management of disease activity in UC is an independent predictor of the need for colectomy. Future studies will determine whether aggressive medical management may modify the need for colectomy in this cohort.

Author List

Ananthakrishnan AN, Issa M, Beaulieu DB, Skaros S, Knox JF, Lemke K, Emmons J, Lundeen SH, Otterson MF, Binion DG

Authors

Sarah J. Lundeen NP APP Outpatient in the Surgery department at Medical College of Wisconsin
Mary F. Otterson MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Case-Control Studies
Colectomy
Colitis, Ulcerative
Female
Forecasting
Hospitalization
Humans
Male
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors