Abstract Background Severe acute colitis (SAC) in ulcerative colitis (UC) is a therapeutic emergency. Intravenous corticosteroids are the reference treatment, but nearly one-third of patients exhibit steroid resistance, requiring therapeutic escalation or colectomy. Identifying predictors of steroid failure is essential to optimise risk stratification. Methods A retrospective study was conducted in patients hospitalised for inaugural SAC due to UC between January 2000 and October 2025. Clinical, biological, and anamnestic data were collected. Patients were classified as responders or non-responders to corticosteroids using the Travis index. Factors associated with steroid resistance were analysed using univariate analysis (Mann–Whitney test, chi-square test), followed by multivariate analysis (logistic regression). Results Forty-two patients were included, with a mean age of 36.6 ± 14.4 years and a male-to-female sex ratio of 0.68. Among them, 18 patients (42.8%) were steroid-resistant. In univariate analysis, only metabolic syndrome was significantly associated with steroid resistance (p = 0.05). Other evaluated parameters—sex, age, family history of IBD, CRP ≥100 mg/L, albumin ≤25 g/L, UCEIS score, disease extent, smoking status, alcohol consumption, and prior exposure to biologics—were not predictive. In multivariate analysis, none of the parameters, including metabolic syndrome, were independently associated with steroid resistance. Conclusion Metabolic syndrome may represent a factor associated with steroid resistance in inaugural SAC due to UC, although this association was not confirmed in multivariate analysis. Further studies with larger cohorts are needed to clarify its potential role in therapeutic risk stratification. Conflict of interest: Dr. Oueslati, Alaa: No conflict of interest Yacoub, Haythem: No conflict of interest Hajji, Rania: No conflict of interest Dhouha, Cherif: No conflict of interest Debbabi, Habiba: No conflict of interest Hassine, Hajer: No conflict of interest Kchir, Hela: No conflict of interest Maamouri, Nadia: No conflict of interest
Oueslati et al. (Thu,) studied this question.