INTRODUCTION: Acute Severe Ulcerative Colitis (ASUC) is a life threatening condition which requires urgent and aggressive medical therapy to reduce mortality, morbidity and avoid surgery; the mainstay of treatment is intravenous corticosteroids. To facilitate this process it is essential to identify patients at high risk of poor outcomes and emergency colectomy. Numerous risk factors predicting the need for surgery have described in the Western literature both at presentation and on day 3 of intravenous therapy, however there are no local data addressing this issue. As such it is unclear if these predictors are applicable in our setting. The aim of this study is thus to identify risk factors for emergency colectomy in patients admitted to Groote Schuur Hospital with ASUC. METHODS: A retrospective cohort study of 98 patients admitted with ASUC between January 2003 and January 2013 was performed. Clinical, demographic, laboratory, radiological and endoscopic factors on admission and 3 days thereafter were analysed as predictors of colectomy by univariate and multivariate analysis. Patients were followed up retrospectively for 90 days RESULTS: Twenty five percent of the cohort underwent emergency colectomy, 80% within 15 days of presentation. On univariate analysis factors on admission which predicted colectomy were exposure to oral corticosteroids (p=0.01), megacolon (p=0.049) or mucosal islands (p=0.04) on abdominal Xray, and a short duration from UC diagnosis until presentation with ASUC (p=0.04). There was no significant association between ethnicity, age at UC diagnosis, gender, family history of IBD, or smoking status. There was also no association with baseline haemoglobin or CRP. The only day 3 variable that significantly predicted colectomy was serum albumin (p=0.01).This was also the only variable to remain significant on multivariate analysis (OR 0.79, 95% CI 0.65-0.97, p=0.01). CONCLUSION: ASUC is a medical emergency, predicting which patients will likely require colectomy is a very valuable tool in guiding therapeutic management. In our study the only variable significantly associated with colectomy was hypoalbuminaemia on day 3. However given the small study numbers a larger prospective study would be of value in identifying additional risk factors.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/22779 |
| Date | January 2016 |
| Creators | Mokhele, Nnete Nimrod |
| Contributors | Watermeyer, Gillian |
| Publisher | University of Cape Town, Faculty of Health Sciences, Division of Surgical Gastroenterology |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
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