Lindgren et al reported a simple score for identifying a patient at increased risk of failing steroid therapy and requiring colectomy during an admission for a severe attack of ulcerative colitis. The authors are from University Hospital Malmo in Sweden.
Patient selection: severe attack of ulcerative colitis, started on glucocorticoids
Predictors of therapeutic failure with colectomy within 30 days:
(1) serum CRP >= 25 mg/L on day 3 of hospitalization
(2) > 4 bowel movements per day on day 3 of hospitalization
score based on day 3 data =
= (number of bowel movements) + 0.14 * (CRP))
Interpretation:
• A score > 8 is associated with failure of medical therapy
Other predictors:
(1) sustained elevation of body temperature
(2) persistent bloody diarrhea
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