急性重度溃疡性结肠炎患者住院后短期与长期类固醇减量策略:临床结果比较。

IF 1.8 Q3 GASTROENTEROLOGY & HEPATOLOGY
Crohn's & Colitis 360 Pub Date : 2024-04-27 eCollection Date: 2024-04-01 DOI:10.1093/crocol/otae025
Mohammad Alomari, Pravallika Chadalavada, Sadaf Afraz, Mu'ed AlGhadir-AlKhalaileh, Zoilo K Suarez, Alec Swartz, Mamoon Rashid, Shrouq Khazaaleh, Benjamin L Cohen, Asad Ur Rahman, Mohammad Alomari
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引用次数: 0

摘要

背景:溃疡性结肠炎(UC)是一种慢性结肠炎性疾病,其特点是复发和缓解发作。然而,急性重症 UC(ASUC)住院患者的最佳类固醇减量策略仍相对未知。我们旨在研究因急性重度UC住院的患者出院时不同泼尼松减量方案的临床效果:我们回顾性研究了 2000 年至 2022 年期间本院收治的所有 ASUC 成人患者。根据出院时类固醇减量的持续时间(6 周)将患者分为两组。入院时接受结肠切除术的患者不在分析之列。主要结果是入院后6个月内因ASUC再次入院。次要结果包括是否需要进行结肠切除术、随访期间(6 个月)内镜下疾病范围和/或严重程度是否恶化,以及作为疾病恶化替代指标的综合结果(定义为上述所有结果的组合)。连续变量和分类变量的均值比较分别采用双样本 t 检验和皮尔逊卡方检验。进行了多变量逻辑回归分析,以确定ASUC再住院的独立预测因素:共分析了 215 名患者(短期类固醇减量=91 人,长期类固醇减量=124 人)。长效类固醇减量组中有更多的患者自诊断以来病程较长,内镜下疾病活动度为中度-重度(分别为 63.8 个月和 25.6 个月,P = ≤ .05)。两组患者的疾病程度、之前接受的生物治疗以及住院抢救治疗的需求相似。随访 6 个月时,两组患者因 UC 复发而再次住院的比例相当(68.3% vs. 68.5%,P = .723)。在单变量和多变量逻辑回归中,出院后四周内类固醇剂量的增加(aOR 6.09,95% CI:1.82-20.3,P = .003)是ASUC再次住院的唯一独立预测因素:这是第一项比较ASUC住院患者出院后类固醇减量方案临床疗效的研究。出院后两种类固醇减量方案的临床效果相当。因此,我们建议将短期类固醇减量作为 ASUC 患者出院后的标准策略。这可能会提高患者的耐受性,减少类固醇相关的不良反应,而不会对治疗效果产生不利影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Post-hospitalization Short Versus Long Steroid Taper Strategies in Patients With Acute Severe Ulcerative Colitis: A Comparison of Clinical Outcomes.

Background: Ulcerative colitis (UC) is a chronic inflammatory colon disease characterized by relapsing flares and remission episodes. However, the optimal steroid tapering strategy in patients hospitalized for acute severe UC (ASUC) remains relatively unknown. We aim to examine the clinical outcomes in patients hospitalized for ASUC regarding variable prednisone taper regimens upon discharge.

Methods: We retrospectively reviewed all adult patients admitted to our facility with ASUC between 2000 and 2022. Patients were divided into 2 groups based on the duration of steroid taper on discharge (< 6 and > 6 weeks). Patients who had colectomy at index admission were excluded from the analysis. The primary outcome was rehospitalization for ASUC within 6 months of index admission. Secondary outcomes included the need for colectomy, worsening endoscopic disease extent and/or severity during the follow-up period (6 months), and a composite outcome as a surrogate of worsening disease (defined as a combination of all products above). Two-sample t-tests and Pearson's chi-square tests were used to compare the means of continuous and categorical variables, respectively. Multivariate logistic regression analysis was performed to identify independent predictors for rehospitalization with ASUC.

Results: A total of 215 patients (short steroid taper = 91 and long steroid taper = 124) were analyzed. A higher number of patients in the long steroid taper group had a longer disease duration since diagnosis and moderate-severe endoscopic disease activity (63.8 vs. 25.6 months, p < 0.0001, 46.8% vs. 23.1%, P = ≤ .05, respectively). Both groups had similar disease extent, prior biologic therapy, and the need for inpatient rescue therapy. At the 6-month follow-up, rates of rehospitalization with a flare of UC were comparable between the 2 groups (68.3% vs. 68.5%, P = .723). On univariate and multivariate logistic regression, escalation of steroid dose within four weeks of discharge (aOR 6.09, 95% CI: 1.82-20.3, P  = .003) was noted to be the only independent predictor for rehospitalization with ASUC.

Conclusions: This is the first study comparing clinical outcomes between post-discharge steroid tapering regimens in hospitalized patients for ASUC. Both examined steroid taper regimens upon discharge showed comparable clinical results. Hence, we suggest a short steroid taper as a standard post-hospitalization strategy in patients following ASUC encounters. It is likely to enhance patient tolerability and reduce steroid-related adverse effects without adversely affecting outcomes.

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来源期刊
Crohn's & Colitis 360
Crohn's & Colitis 360 Medicine-Gastroenterology
CiteScore
2.50
自引率
0.00%
发文量
41
审稿时长
12 weeks
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