P0461 Does Number of Truelove and Witts’ Systemic Criteria at Time of Presentation with Acute Severe Ulcerative Colitis have an Effect on Severity of Systemic Features and Patient Outcomes?
Authors: Wu M Y , Nario S , Tung C , Kiely C 
Published: January 2025

Abstract

Background
Acute Severe Ulcerative Colitis (ASUC) is a medical emergency that occurs in 15-25% of UC patients during their disease course. The Truelove and Witts’ criteria (TWC) is used to identify patients with ASUC at time of presentation. One study showed that patients with more systemic TWC on admission were more likely to undergo colectomy, but no other outcomes were reported.1 We hypothesised that an increasing number of TWC systemic features at time of presentation would correlate with systemic toxicity, which may impact on patient outcomes. Specifically, we evaluated whether patients with ASUC who had a higher number of TWC systemic features was associated with timely investigations, use of empiric antibiotics, rescue therapy and need for colectomy.

Methods
A retrospective review was conducted on all ASUC presentations to a quaternary Sydney hospital over a 10-year period (January 2014 to May 2024). A modified TWC was used to identify ASUC as ≥6 bloody bowel motions daily and presence of at least one systemic feature, including heart rate (HR) &gt;90 bpm, temperature &gt;37.8°C, haemoglobin (Hb) &lt;105 g/L, and C-reactive protein (CRP) ≥30 mg/L.2 Patients were classified based on number of systemic TWC met at time of presentation. Data on antibiotic prescription, time taken for abdominal imaging (XR or CT), time to flexible sigmoidoscopy, time to and use of rescue therapy, time taken for surgical review and colectomy, and length of stay were compared between groups.

Results
During the study period, there were a total of 617 presentations to hospital with ulcerative colitis and 172 ASUC presentations, as defined by TWC. Most presentations had ≤2 systemic features present (73.8%, n= 127). Figure 1 demonstrates that systemic toxicity was increased in patients who had more than one TWC systemic feature at time of presentation. These patients had higher average HR (p &lt;0.05), higher temperature (p &lt;0.05), higher CRP (p &lt;0.05), and lower Hb (p &lt;0.05). Table 1 shows comparative results of investigation and treatment outcomes in those presenting with one, two, three or four systemic features.

Conclusion
ASUC patients with more TWC systemic features on presentation had significantly increased features of systemic toxicity, with higher average HR, temperature, CRP and lower Hb. Patients presenting with a higher number of TWC systemic features may allow clinicians to more easily recognise ASUC and therefore, were more likely to receive empirical antibiotics and timely flexible sigmoidoscopy. However, treatment outcomes, as defined by need for, and time to rescue therapy, colorectal surgery review, colectomy and length of stay, appeared similar regardless of number of TWC systemic features present and evidence of systemic toxicity on presentation.

References
1.Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis. 2010;4(4):431-437. doi:10.1016/J.CROHNS.2010.02.001
2.Sturm A, Maaser C, Calabrese E, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis. 2019;13(3):273-284. doi:10.1093/ECCO-JCC/JJY114