Early predictors of surgery in patients with acute severe ulcerative colitis results of the ESCP MASC study.

Background: We aimed to identify early predictors of failure to medical treatment and need of colectomy in patients with Acute Severe Ulcerative Colitis (ASUC).
Methods: In a prospective, international study, consecutive patients hospitalized for ASUC over 1 year were included. Data were uploaded in a secure online database. Need for surgery during the first 90 days was considered as the primary outcome. A multivariate regression was created to identify early predictors of colectomy. The Study was led by the ESCP https://tinyurl.com/vfwmahva
Results: 699 patients from 123 centres (32 countries) were analysed. 265(38%) had previous admissions for UC, and 39(6%) had undergone appendicectomy. 441(63%) were successfully treated medically; 258 (37%) required surgery. Median length of stay was 12 days and mortality rate 1%. In those requiring surgery, postoperative morbidity was 36%, surgical site infection 26%, reoperation 8%. Predictors of colectomy were being current smokers (OR 2.1, 95 CI 1.04-4.25), previous admission (OR 2.4, 95 CI 1.5-3.8), and previous appendicectomy(OR 8.2, 95 CI 3.2-20.9).
Conclusions: The mortality rate of ASUC was lower than previously described. Patients who currently smoked, with previous admission for UC, and with previous appendicectomy had an increased risk of medical failure and need for surgery. Some of the findings seem to be conflicting with available evidence and might need further investigation.