P593 Predictors of steroid-resistance in severe colitis of inflammatory bowel disease
C. JEMMALI1, A. Labidi2, M.A. Jouini2, M. Hafi2, M. Serghini2, M. Fekih2, J. Boubaker2
1Faculty of Medicine of Tunis, Gastroenterology A Rabta, Tunis, Tunisia, 2Rabta, Gastroenterology A, Tunis, Tunisia
Background
Intravenous steroids (IVS) remain the mainstay of therapy in severe colitis of inflammatory bowel disease (IBD), although 30 to 40% of patients will not respond. In such cases, rescue medical therapy with immunomodulators, or an early colectomy are considered. The aim of this study was to identify predictor factors of corticosteroid failure during severe colitis in IBD patients.
Methods
We conducted a 5-year retrospective study (2014–2019), including all IBD patients with severe colitis. Diagnosis was based on clinical, biochemical markers and endoscopic criteria. All patients received conventional first-line therapy with IVS. Corticosteroid failure was defined according to Travis criteria.
Results
A total of 40 patients with a mean age of 36 ± 13.1 years and a sex ratio H / F of 0.6 were included. Twenty-three patients (57.5%) had ulcerative colitis (UC) while 17 patients (42.5%) had Crohn’s disease (CD). The average duration of IBD in all patients was 28.8 ± 52.1 months. Severe colitis was the first flare of the disease in fifteen patients (37.5%). Twenty-seven patients (67.5%) respond to IVS. Factors associated with steroid failure on admission were type of IBD (UC) (p = 0.03), presence of fever (T≥ 38°C) (p = 0.04) and blood transfusion (p = 0.02). Biochemical predictors of steroid failure were low hematocrit rate (<28%) (
Conclusion
In conclusion, stratification of risk in IBD patients with severe colitis should be considered early on admission and at the latest on day 3 of IVS in order to select patients at high risk of steroid failure and then decide to start rescue therapy.