P1049 Intestinal ultrasound for assessment of steroid-refractory disease in patients hospitalized due to Acute Severe Colitis
Authors: Kornowski Cohen M , Lev Kolnik R , Avni I , Snir Y , Broitman Y , Sharar Fischler T , Yanai H , Dotan I , Ollech J , Banai Eran H 
Published: January 2025

Abstract

Background
Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition. Intravenous corticosteroids are recommended as the initial treatment for adult patients with ASUC. However, one-third of patients with ASUC are steroid-refractory and will require medical salvage therapy or surgery. Timely identification of patients who will not adequately respond to steroid treatment is crucial. This study aimed to evaluate whether intestinal ultrasound (IUS), could potentially be of additional value in predicting inadequate response to IV steroids in patients admitted with ASUC.

Methods
A retrospective cohort study was conducted including all patients with ASUC admitted between 1/2018-12/2023 to a large tertiary referral center (Rabin Medical Center) in Israel. All patients who had laboratory tests, sigmoidoscopy and IUS were included. We used inflammatory markers, Milan Ultrasound Criteria (MUC) and Mayo endoscopic score (EMS) to assess disease activity. The need for in hospital salvage therapy (infliximab or cyclosporine) was detected.

Results
Out of 158 patients with ASUC admitted during the study period, baseline IUS was available in 43. Medical salvage therapy was required in 19 (44%): infliximab n=13, cyclosporine n=6. Patients ultimately requiring salvage therapy during their hospitalization had significantly worse laboratory baseline disease activity parameters. Specifically, median albumin, hemoglobin and c-reactive protein were 2.5 vs. 3.7 g/dl; 8.9 vs 11.9 g/dl; and 10.2 vs. 6.8 mg/dl in the salvage therapy group vs. steroid therapy only group, respectively (p&lt;0.05). An EMS of 3 was detected in 14/19 (74%) of patients requiring medical salvage therapy compared to 14/24 (58%) in the steroid therapy only group. Finally, bowel wall thickness (BWT) and MUC of the sigmoid colon in the medical salvage therapy group was 5.1, 9 compared to 4.9, 8.5 in the steroid therapy only group (p&gt;0.05).

Conclusion
In patients hospitalized with ASUC, laboratory values were significantly worse in patients ultimately needing salvage therapy. IUS measurements were not significantly different between these two groups. In this sick subgroup of patients with ASUC, IUS was not able to provide additional information regarding the risk of steroid failure. Defining specific cutoffs in larger studies may contribute to early non-invasive risk-stratification.

References
1.Allocca M, Filippi E, et al. Milan ultrasound criteria are accurate in assessing disease activity in ulcerative colitis: external validation. United European Gastroenterol J. 2021 May;9(4):438-442.
2.Javier P Gisbert, María José García, et al. Rescue Therapies for Steroid-refractory Acute Severe Ulcerative Colitis: A Review. Journal of Crohn’s and Colitis, Volume 17, Issue 6, June 2023: 972–994
3.Piazza O Sed N, Noviello D, et al. Superior predictive value of transmural over endoscopic severity for colectomy risk in ulcerative colitis: a multicentre prospective cohort study. J Crohns Colitis. 2024 Feb 26;18(2):291-299.
4.Adams A, Gupta V, et al. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut. 2023 Mar;72(3):433-442.