Day 3 Oxford Criteria Predict Steroid non-response for Acute Severe Ulcerative Colitis in the Post Biologic Era.

Background and aims: Outcomes of patients admitted with acute severe ulcerative colitis(ASUC) in the post biologic era are under explored, as well as ability of scoring indices to predict early steroid non-response.

Methods: This Retrospective cohort study included adults hospitalized with ASUC(2010-2022) at London Health Sciences Centre, Canada. Steroid response, need for rescue therapy, colectomy during index hospitalization and colectomy and hospitalization at 3- and 12-months following discharge was assessed. Logistic regression identified predictors of steroid non-response, defined as need for rescue therapy or colectomy during hospitalization.

Results: Of 261 adults hospitalized with ASUC(male : 51.7%, mean age : 40.6 years), 71.2% had extensive colitis. After intravenous corticosteroid therapy during index admission, 55.7%(n = 147) had response, 37.9%(n = 99) received rescue therapy (infliximab: 98, tofacitinib: 1 and cyclosporine: 0), and 8%(21/261) underwent colectomy. Additionally, 11.6%(28/240) of patients discharged from hospital underwent colectomy within the first 12 months (8.3% at 3-months and 3.3% between 3-12 months). There was no difference between steroid responders and steroid non-responders for colectomy(11%vs12.6%) or hospitalization(33.5%vs32.6%) at 12 months. The overall cumulative probabilities of colectomy of entire cohort at 1 year, 3 years and 5 years were 13.5%, 16.1%, and 17.4%, respectively. On multivariate analysis, Day-3 Oxford criteria was the only factor found to be statistically significant in predicting steroid non-response(odds ratio 4.70, 95%CI [1.06-20.80]).

Conclusions: Day-3 Oxford criteria was an independent predictor of steroid non-response. The risk of colectomy remains substantial after discharge despite low in-hospital colectomy rate following an episode of ASUC. Initial steroid response did not affect long-term colectomy rate at 12 months.