CT-Visualized Colonic Mural Stratification Independently Predicts the Need for Medical or Surgical Rescue Therapy in Hospitalized Ulcerative Colitis Patients.

backgroundSevere ulcerative colitis is associated with significant morbidity. Multidetector computed tomography (MDCT) scans are frequently obtained upon hospital admission, but the ability of radiographic findings to predict steroid failure is unknown.

aimTo identify MDCT features predictive of inpatient rescue in hospitalized UC.

methodsPatients hospitalized with UC who underwent a CT scan within 48 h of hospitalization were retrospectively identified. Radiologists blinded to the outcome prospectively evaluated CT scans for the presence of bowel wall thickening, stranding, and hyperenhancement as well as mural stratification, mesenteric hyperemia, and proximal dilation. Logistic regression adjusting for potential confounders was used to test the independent association between radiographic findings and need for rescue therapy.

resultsThe study cohort included 74 patients. The mean age of the group was 45 years, and two-thirds (66%) were male. Twenty-eight (38%) patients required either inpatient medical rescue or colectomy. The mean number of positive radiographic findings was 4.4 (range 2-6) with a higher median number of findings in those who required rescue therapy (5 vs. 4, p = 0.03). Mural stratification was significantly more common among those who required rescue therapy (92% vs. 49%, p = 0.001). No other radiographic findings were independently associated with inpatient rescue. On multivariable analysis, mural stratification (OR 14.9, 95% CI 2.76-80.2) and number of positive findings (OR 2.10, 95% CI 1.06-4.16) remained independently predictive of the need for rescue therapy.

conclusionsMural stratification was highly predictive of steroid refractoriness and need for medical or surgical rescue therapy in hospitalized UC.