P368 The presence of extra-intestinal manifestations is associated with poor prognosis in acute severe ulcerative colitis: A KASID multicenter study
Kim, D.H.(1);Kim, E.S.(2);Kim, H.S.(3)*;Park, S.H.(4);Kim, S.J.(5);Kim, K.O.(6);Lee, Y.J.(7);Song, E.M.(8);Kim, D.S.(9);Lee, J.(5);
(1)Chonnam National University Hospital, Division of gastroenterology- Department of Internal medicine and Inflammatory Bowel disease Clinic, Gwnagju, Korea- Republic Of;(2)Kyungpook University Hospital, Department of Internal Medicine- Division of gastroenterology, Daegu, Korea- Republic Of;(3)Chonnam National University Hospital, Department of Internal Medicine- Division of gastroenterology, Gwangju, Korea- Republic Of;(4)Asan Medical Center, Department of Internal Medicine- Division of gastroenterology, Seoul, Korea- Republic Of;(5)Chosun University Hospital, Department of Internal Medicine- Division of Gastroenterology, Gwangju, Korea- Republic Of;(6)Yeungnam University Hospital, Department of Internal Medicine- Division of gastroenterology, Daegu, Korea- Republic Of;(7)Keimyung University Hospital, Department of Internal Medicine- Division of Gastroenterology, Daegu, Korea- Republic Of;(8)Ewha Womans University Seoul Hospital, Department of Internal Medicine- Division of Gastroenterology, Seoul, Korea- Republic Of;(9)Konyang University Hospital, Department of Internal Medicine- Division of Gastroenterology, Daejeon, Korea- Republic Of; IBD Research Group in Korean Association for the Study of the Intestinal Diseases (KASID)
Background
Many patients with inflammatory bowel disease experience extra-intestinal manifestations (EIM)s. The presence of EIMs is related to disease activity. Acute severe ulcerative colitis (ASUC) is associated with a high inflammatory burden. However, there are insufficient studies on the relation between the presence of EIMs and the prognosis of exacerbation of ulcerative colitis. This study was conducted to elucidate the correlation between EIMs and ASUC.
Methods
We retrospectively included patients who were hospitalized at four tertiary medical centers for ASUC management between January 2015 to December 2020, and data on the underlying disease, disease activity, EIMs, colectomy, treatment method, and readmission due to ulcerative colitis aggravation were checked.
Results
A total of 145 patients (mean age 44.4 years, 68 women) were investigated. The initial partial Mayo score, the Mayo endoscopy sub-score, and the ulcerative colitis endoscopic severity index were 7.6±0.8%, 2.7±0.5, and 6.0±1.4%, respectively.
EIMs were expressed in a total of 10.3% (15/145) of patients. The most common type of EIMs was the peripheral articular type (46.7%) followed by skin lesions (20%) and axial articular disease (13.3%). The group with EIMs was younger and had a higher proportion of women than the group without EIMs (39.4 versus 45 years, p=0.03), and had a longer duration of disease (5.8 versus 3.5 years, p=0.02). The Mayo endoscopic sub-score (2.9 vs. 2.7, p<0.01) and partial endoscopic score (7.9 vs. 7.6, p<0.01) were also higher in the EIMs group. The length of hospital stay was also longer in the EIMs group (25.5 days vs. 13.8 days, p<0.01).
The response rate to initial treatment was lower in the EIMs group (71.4% vs. 95.5%, p<0.01), and more rescue therapy (28.6% vs. 4.5%, p<0.01) was performed. The rate of colectomy on admission was also higher in the group with EIMs (13.3% vs. 0.8%, p<0.01). Patients with EIMs showed a high tendency to visit the hospital for re-exacerbation of ulcerative colitis after discharge (p=0.07, HR 2.10 CI: 0.93 – 4.76).
Conclusion
EIMs were expressed in a total of 10.3% of patients with ASUC. The presence of EIMs suggested a poor prognosis in ASUC.