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

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Abstract

Background

Severe 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.

Aim

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

Methods

Patients 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.

Results

The 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.

Conclusions

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

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Funding

Ananthakrishnan is funded by the Crohn’s and Colitis Foundation and National Institutes of Health (R03 DK112909). This work is supported by the National Institutes of Health (P30 DK043351) to the Center for Study of Inflammatory Bowel Diseases.

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Authors and Affiliations

  1. Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA

    Kelly C. Cushing & Ashwin N. Ananthakrishnan

  2. Harvard Medical School, Boston, MA, USA

    Kelly C. Cushing, Hamed Kordbacheh, Michael S. Gee, Avinash Kambadakone & Ashwin N. Ananthakrishnan

  3. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Hamed Kordbacheh, Michael S. Gee & Avinash Kambadakone

  4. Massachusetts General Hospital Crohn’s and Colitis Centre, 165 Cambridge Street, 9th Floor, Boston, MA, 02114, USA

    Ashwin N. Ananthakrishnan

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  1. Kelly C. Cushing
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Correspondence to Ashwin N. Ananthakrishnan.

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Conflict of interest

Cushing, Kordbacheh, Gee, and Kambadakone have no conflicts of interests to declare. Ananthakrishnan has served on scientific advisory boards for Abbvie, Gilead, Takeda, and Merck.

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Cushing, K.C., Kordbacheh, H., Gee, M.S. et al. CT-Visualized Colonic Mural Stratification Independently Predicts the Need for Medical or Surgical Rescue Therapy in Hospitalized Ulcerative Colitis Patients. Dig Dis Sci 64, 2265–2272 (2019). https://doi.org/10.1007/s10620-019-05520-x

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  • DOI: https://doi.org/10.1007/s10620-019-05520-x

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