Outcomes of Outpatient Advanced Therapy Exposed Patients Hospitalized With Severe Ulcerative Colitis.

Background: Contemporary characteristics of hospitalized patients with ulcerative colitis (UC) may differ from historic standards in terms of prior drug exposure and disease severity. The impact of these differences on outcomes is unclear. This study aimed to assess inpatient UC outcomes according to prior outpatient drug exposure and measures of disease severity.

Methods: This was a multicenter, retrospective study of adult patients (age ≥ 18 years) hospitalized for severe UC. The primary outcome was the colectomy rate among outpatient advanced therapy exposed (ATE) vs advanced therapy naïve (ATN) patients. Secondary outcomes included length of hospitalization and need for rescue medical therapy.

Results: A total of 370 patients were included with 86 (23%) in the ATE group and 284 (77%) in the ATN group. In the ATE group, 21 patients (25%) required colectomy vs 26 (9%) in the ATN group (P < .001). Median hospital length of stay was 6 days (IQR: 4-9) in both groups (P = .96). Rescue medical therapy was required in 107 (38%) patients in the ATN group vs 36 (42%) in the ATE group (P = .49).Colectomy was associated with ATE status (P = .0002), Mayo UC endoscopic sub-score of 3 (P = .002), higher C-reactive protein (P = .04), lower albumin (P = .0002), and female sex (P = .03). On multivariable analysis, only low albumin was independently associated with colectomy (P = .001).

Conclusions: Outpatient ATE was associated with an increased risk of colectomy among hospitalized patients with severe UC. On multivariable analysis, low albumin was independently associated with the risk of colectomy. This suggests that higher colectomy rates observed in ATE patients may reflect underlying differences in disease severity.