Abstract BACKGROUND Acute severe ulcerative colitis (ASUC) is a serious and life-threatening complication of ulcerative colitis. Elderly patients with severe ulcerative colitis (UC) often experience a more challenging disease course compared to younger patients. Method A retrospective chart review was conducted on patients diagnosed with ASUC and admitted to Mayo Clinic Rochester, Minnesota, and Florida, from 2013 to 2022. Patients aged 65 and above at the time of admission were included in the study. IRB approval was obtained. RESULTS We reviewed 120 records. The median age at diagnosis of ulcerative colitis was 64 years, and median age at admission was 71 years, with a median disease duration of 5 years prior to presentation. There were 66 males (56%). 86 patients (72%) had pancolitis. 65 patients (55%) never smoked, 50 patients (42%) were former smokers, and 4 (3.4%) patients were current smokers. The mean Charlson Comorbidity Index was 4.6, and median BMI was 27. Medication use prior to admission included steroids 73 patients (61%), Mesalamine in 83 patients (70%A), Anti TNF 35 patients (30%), prior Vedolizumab 31 (26%), prior Ustekinumab 4 patients (3%), prior JAK inhibitor 4 patients (3%) prior Ozanimod in 2 patients (1.7%). Laboratory parameters at admission include a mean Hemoglobin 10 gm/dl, CRP 67 mg/dl, WBC 9/microliter, Albumin 3.1 g/dl, Fecal Calprotectin 1060 microgram/g. Endoscopic findings include a Mayo 3 score 84% and Mayo 2 in 16% patients. CMV infection was found in 7 patients, and C difficile in 24 patients within a month of hospital admission. In hospital treatment included IV steroids in 91% patients and IV Infliximab in 20%. Therapy after discharge includes Anti TNF agents in 27%, Vedolizumab in 27%, Ustekinumab in 3% and JAK inhibitors in 3%. Colectomy during index hospitalization occurred in 25% and during the first month after discharge in 8%, with a total colectomy rate of about 32%. Readmission within a month of discharge occurred in 12% patients. Death within a year occurred in 15% patients. DISCUSSION A significant proportion of elderly patients admitted with ASUC underwent colectomy and had a high mortality. Using multivariate analysis, prior use of steroids and anti-TNF agents and use of Infliximab in the hospital were significant predictors for colectomy, whereas female sex emerged as an independent protective factor. Early recognition of disease and multidisciplinary care are essential to optimize outcomes. Further prospective studies and clinical trials focused on older adults are needed to generate evidence-based guidelines.
Navreet Chowla (Thu,) studied this question.