Abstract Background Acute severe ulcerative colitis (ASUC) requires rapid diagnosis and timely escalation of therapy, yet prospective real-world data from Asian populations remain limited. We established a multicenter prospective cohort in Korea to characterize baseline features and real-world management patterns, including rescue therapy use, among hospitalized patients with ASUC. Methods We conducted a multicenter prospective cohort study enrolling adults hospitalized with ASUC. Baseline demographics, disease extent, laboratory markers, endoscopic severity, and treatment details were recorded. Clinical and endoscopic activity were assessed using the Lichtiger score and UCEIS. The use of intravenous steroids, antibiotics, thromboprophylaxis, and first- to third-line rescue therapy was documented. Data were summarized descriptively. Results A total of 33 patients with acute severe ulcerative colitis were enrolled. The mean age was 42.6 ± 15.3 years, and 54.5% were male. Extensive colitis (E3) was present in 66.7%, and only one patient (3.0%) reported a family history of IBD. Extraintestinal manifestations were uncommon, including arthritis in 2 patients (6.1%). Before admission, 84.8% had used systemic steroids (median dose 25 mg), 78.8% had used azathioprine, and 3.0% had used 5-ASA. Most patients (86.7%) were biologic-naïve. At admission, the mean CRP was 4.9 ± 5.6 mg/dL, mean hemoglobin 10.0 ± 1.3 g/dL, baseline UCEIS 5.3 ± 1.2, Partial Mayo 6.4 ± 0.8, and Lichtiger score 13.4 ± 2.1, consistent with severe disease. All patients received intravenous corticosteroids as initial therapy. Rescue therapy was required in 45.5% (15/33). First-line rescue treatments included infliximab in 13 patients (39.4%), adalimumab in one (3.0%), and vedolizumab in one (3.0%). Two patients (6.1%) required second-line escalation (ustekinumab and upadacitinib), and one patient (3.0%) required third-line escalation with upadacitinib. No patient required colectomy, and no in-hospital mortality occurred. Conclusion In this prospective multicenter ASUC cohort, nearly half required rescue therapy, predominantly infliximab, with minimal need for further escalation. No colectomy or mortality occurred. These findings describe current real-world management patterns and favorable short-term safety outcomes in Korean ASUC patients. References: 1. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. The American journal of gastroenterology. 2010;105(3):501-523; quiz 524. 2. Choi CH, Moon W, Kim YS, et al. Second Korean Guideline for the Management of Ulcerative Colitis. The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi. 2017;69(1):1-28. 3. Ng WK, Wong SH, Ng SC. Changing epidemiological trends of inflammatory bowel disease in Asia. Intestinal research. 2016;14(2):111-119. 4. Ooi CJ, Fock KM, Makharia GK, et al. The Asia-Pacific consensus on ulcerative colitis. Journal of gastroenterology and hepatology. 2010;25(3):453-468. 5. Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1-s106. Conflict of interest: Mr. Kim, Dong Hyun: No conflict of interest Park, Soo Jung: No conflict of interest Moon, Won: No conflicts Na, Soo-Young: No conflict of interest Lee, Hong Sub: No conflict of interest Lee, Yoo Jin: No conflict of interest Park, Yehyun: No conflict of interest Kim, Hyun-Soo: No conflict of interest Hong, Sung Noh: Grant: National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (2019R1A2C2010404) Future Medicine 20*30 Project of the Samsung Medical Center.
Kim et al. (Thu,) studied this question.