Early predictors of glucocorticosteroid treatment failure in severe and moderately severe attacks of ulcerative colitis

Eur J Gastroenterol Hepatol. 1998 Oct;10(10):831-5. doi: 10.1097/00042737-199810000-00003.


Objective: To analyse the ability of simple clinical and biochemical parameters to predict glucocorticosteroid (GCS) treatment failure in patients with acute attacks of ulcerative colitis.

Design/methods: Retrospective analysis of clinical and biochemical data.

Setting: Four Swedish university hospitals.

Patients: Ninety seven patients with acute attacks of ulcerative colitis severe enough to warrant treatment with intravenous GCS, hospitalized during the years 1988-93.

Main outcome measure: Colectomy within the first 30 days after hospitalization, defined as 'clinical steroid resistance'.

Results: Thirty days after admission, 39 patients (40%) were in complete clinical and endoscopic remission while 33 (34%) had undergone colectomy. During follow-up for 24 months, four patients among the 39 initially in remission underwent colectomy. Among the 25 patients (26%) not attaining remission after 30 days, an additional nine patients subsequently required colectomy. Steroid resistance was associated with duration of disease (2.7 vs 8.1 years, P=0.0037) and steroid treatment before hospitalization (70 vs 42%, P=0.010). In particular, elevation of body temperature (37.4 vs 36.9 degrees C, P=0.012), persistence of diarrhoea (6.8 vs 3.6 bowel movements/day, P<0.0001) and passage of blood (83 vs 42%, P=0.0003) as well as CRP elevation (36.3 vs 18.0 mg/l, P=0.007) on day 3 after treatment initiation were identified as predictors of a poor response. CRP > or = 25 mg/l and > 4 bowel movements/day on day 3 of hospitalization independently predicted a high risk for colectomy within 30 days.

Conclusions: Sustained elevation of body temperature, persistent bloody diarrhoea and continued CRP elevation on day 3 of intravenous GCS treatment strongly predict clinical steroid resistance in acute attacks of ulcerative colitis. In the group of poor or non-responders, colectomy or more aggressive medical treatment should be considered at an early stage.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Colitis, Ulcerative / drug therapy*
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Failure


  • Glucocorticoids