Predictors of Steroid Treatment Failure and Validation of Previous Models for Severe Attacks of Ulcerative Colitis

Kim, Jung Wook; Kim, Hyo Jong; Lee, Chang Kyun; Kim, Hyuck; Shin, A Ri; Kang, Kyung Hwan; Kim, Min Kyoung; Park, Hyun Jin; Chung, Hoe Hoon; Hwang, Eun Jung

Abstract

BACKGROUND/AIMS
Some clinical and laboratory parameter are predictors to determine steroid treatment failure in patients acute severe ulcerative colitis. We aimed to validate previous models in the Korean patients.
METHODS
This study was conducted retrospectively with 70 patients who were diagnosed with severe ulcerative colitis (UC) between January 2001 and June 2011. The rate of treatment failure was investigated using predictors or numerical scoring systems from prior studies.
RESULTS
Twelve (17.2%) patients failed to respond to steroid therapy. The logistic regression analysis revealed that stool frequency on the fifth day and colonic dilatation were the only independent predictive factors related to treatment failure. Formulated numerical risk scores based on mean stool frequency, colonic dilatation, and hypoalbuminemia were significantly higher in the non-responding group than those in the responding group (P<0.001). Using another scoring system (stool frequency on the third day+1.4xC-reactive protein [CRP]), treatment failure rate was significantly higher in the group in which the score was >8 than in the group with a score <8 (30.8% vs. 8.6%, P=0.042). Lastly, treatment failure rate was higher in the group (stool frequency >8 plus CRP >4.5 mg/dL or bloody stool plus CRP >4.3 mg/dL) than those of the other group at the third day (40% vs. 7.3%, P=0.004; 33.3% vs. 5.2%, P=0.014, respectively).
CONCLUSIONS
Stool frequency and CRP level were the meaningful parameters among the predictors for steroid treatment response. Furthermore, several predictive models for steroid treatment failure in western countries seem to be of value for use in the Korean population.