Background: Acute severe ulcerative colitis (ASUC) is a serious and life-threatening complication of ulcerative colitis (UC). Elderly patients with ASUC often experience a more challenging disease course compared to younger patients. We aimed to describe our experience of management of ASUC among patients > 65 years.
Method: A retrospective chart review was conducted on patients aged 65 and older diagnosed with ASUC and admitted to three tertiary care centers from 2013 to 2022. UC was confirmed based on clinical presentation and histopathological data. Data on demographics, history of inflammatory bowel disease (IBD), Charlson comorbidity index and outcomes including colectomy rates during hospitalization or within 30 days were collected. Additionally, rates of readmission and mortality at one year were assessed.
Results : A total of 120 patients (56% males) were included. Median age at diagnosis of UC was 64 (18-88 yrs), median age of ASUC admission was 71 (63-91 yrs), with median disease duration of 5 yrs years prior to admission. 86 patients (72%) had pancolitis. 65 patients (55%) never smoked and 50 patients (42%) were former smokers, The median Charlson Comorbidity Index was 4 ( 2-14), and median BMI was 27 (15-51).
Prior medication included steroids in 73 patients (61%), Mesalamine in 83 patients (70%), Anti TNF 35 patients (30%), Vedolizumab 31 (26%), Ustekinumab 4 (3%), JAK inhibitor 4(3%) and Ozanimod in 2 patients (1.7%). Laboratory parameters include median Hemoglobin 10 gm/dl (6-17), CRP 41 mg/dl ( 0-400), WBC 9.3 x 109/L ( 2-28,000), Albumin 3.1 g/dl (1-4), Fecal Calprotectin 1060 mcg/g (13-5000).
Endoscopic findings include a Mayo 3 score in 84% and Mayo 2 in 16% patients.
CMV infection was found in 7 patients (6%), and C difficile in 24 patients (21%)within a month of hospital admission. Treatment during admission included IV steroids in 99% patients and IV Infliximab in 18%. Therapy after discharge included Anti TNF agents in 29%, Vedolizumab in 29%, Ustekinumab in 2 % and JAK inhibitors in 3%. Colectomy during index hospitalization occurred in 25% and during the first month after discharge in 8%, with a total colectomy rate of about 32%. Readmission within a month of discharge occurred in 10% patients. Death within a year occurred in 15% patients.
Using multivariate analysis, prior use of steroids [odds ratio: 2.11 ( 1.89,2.36), p<0.001], prior use of anti-TNF [odds ratio: 1.77 ( 1.59,1.98), p< 0.001], and use of Infliximab salvage therapy [odds ratio: 2.97 ( 2.61, 3.37), p <0.001] were significant predictors for colectomy within 30 days.
Discussion: A significant proportion of elderly patients admitted with ASUC underwent colectomy. Prior use of steroids and anti TNF agents were predictors for colectomy within 30 days of hospitalization. Further studies are needed to improve medical management and outcomes in this vulnerable population.

NAVREET CHOWLA

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