TOPLINE

Among patients hospitalized for ulcerative colitis, those who did not meet the traditional Truelove and Witts Criteria (TWC) for acute severe disease faced a 1-year risk for colectomy similar to that faced by patients who met the criteria. Lowering the C-reactive protein (CRP) threshold from > 30 mg/L to ≥ 12 mg/L helped identify additional patients at a high risk for surgery.

METHODOLOGY

• Although the 70-year-old TWC remain the standard for defining acute severe ulcerative colitis, many hospitalized patients who require intensive treatment fall outside these criteria, raising concerns that the current severity thresholds may underestimate the risk for colectomy in the era of advanced therapies.
• In a retrospective cohort study, researchers analyzed 503 consecutive hospital admissions for acute ulcerative colitis at a tertiary referral center in Australia between 2015 and 2024 to examine the impact of lowering the CRP threshold from > 30 mg/L to ≥ 12 mg/L on disease classification and the identification of patients at a high risk for colectomy.
• Patients were classified as having acute severe ulcerative colitis if they met TWC (n = 358; median age at admission, 33 years; 52% women) or as having nonacute severe ulcerative colitis if they required hospitalization but did not meet these criteria (n = 145; median age at admission, 32 years; 61% women).
• Propensity score matching was used to account for several baseline characteristics; 84 patients with acute severe ulcerative colitis were matched with 84 patients with nonacute severe ulcerative colitis to compare colectomy outcomes.
• The primary outcome was colectomy at 30 days, 90 days, and 1 year.

TAKEAWAY

• Most patients (77%) with nonacute severe ulcerative colitis had a stool frequency ≥ 6 without systemic toxicity; however, 10% underwent colectomy within 1 year despite not meeting TWC for acute severe disease.
• In the matched cohort, the risk for colectomy did not differ significantly between patients with acute severe ulcerative colitis and those with nonacute severe ulcerative colitis at 30 days (9% vs 5%; P = .367), 90 days (11% vs 5%; P = .158), or 1 year (18% vs 13%; P = .479).
• Lowering the CRP threshold from > 30 mg/L to ≥ 12 mg/L reclassified 26% of patients with nonacute severe disease as having acute severe ulcerative colitis and identified 43% of patients with nonacute severe disease who ultimately required colectomy within 1 year; patients reclassified using the CRP threshold of ≥ 12 mg/L had a 1-year risk for colectomy comparable to that observed among patients meeting standard TWC.
• The lowered CRP threshold may not improve risk stratification among patients already exposed to biologic therapy at admission.

IN PRACTICE

“Patients with acute UC [ulcerative colitis] and SF [stool frequency] ≥ 6 per day who present with CRP ≥ 12 mg/L should be considered for intensive inpatient management regardless of whether they meet traditional TWC thresholds, particularly if they have pancolitis, Mayo 3 endoscopic disease, or are receiving biologic therapy at the time of admission,” the authors of the study wrote.

“This simple, evidence-based modification offers an immediately actionable approach to improve risk stratification in contemporary practice,” they added.

SOURCE

The study was led by Amirah Etchegaray, Royal Brisbane and Women’s Hospital in Brisbane, Australia. It was published online in Alimentary Pharmacology & Therapeutics.

LIMITATIONS

The single-center retrospective design limited the generalizability of the findings. Evolving treatment practices over the 10-year study period may have affected colectomy outcomes. Although the CRP threshold of ≥ 12 mg/L improved risk stratification, it requires prospective validation before widespread adoption.

DISCLOSURES

No funding information was provided for this study. Three authors disclosed receiving speaker fees, consultancy fees, research grants, or educational assistance from industry.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.