ASUC can be a life threatening condition for which optimal management strategies within
the acute setting are required. Such strategies remain largely ill-defined with
approximately 30 - 40% of ASUC inpatient admissions requiring emergency colectomy.
Intravenous corticosteroids have been the mainstay of management during the inpatient
admission but approximately 40% of this patient group will be steroid resistant. Although
mortality following emergency colectomy has indeed fallen over time, it still remains as
high as 10% at the 12 week marker. Patients with steroid refractory disease salvage
therapy with infliximab can be considered to avoid colectomy.
Currently there are no predictive indices to identify patients needing rescue therapy.
Hence health care professionals have no tools to 'personalise' care for ASUC by
predicting up front which patients fail initial medical therapy and thus predict those
who may benefit from rescue therapy or early surgery.
Traditionally the Truelove and Witts severity Index is used to define the clinical
severity of disease on admission, but this long-standing index has yet to be validated as
a predictor for the need for colectomy during the acute hospitalised phase. Similarly,
endoscopic indices, including the only validated endoscopic severity score in UC (UCEIS -
Ulcerative Colitis Endoscopic Index of Severity) have not been prospectively evaluated in
the setting of ASUC.
Approximately 30% of ASUC patients treated with rescue anti TNF will fail to respond and
require urgent colectomy. The optimal dosing regimes for rescue therapy with infliximab
remains uncertain.Recently, there have been reports of increasing use of accelerated
induction anti - TNF regimes in patients with ASUC (10mg/kg or shorter intervals) despite
lack of clear evidence to support this practice. Randomised trial evidence for selecting
patients suitable for accelerated induction regimes is not yet currently available and
will require large sample size to elucidate clearly the variables that predict the need
for individual dosing strategies.
Another consideration in the management of ASUC patients is the wide variability in
practices among institutions and clinicians; this may potentially affect quality of care
and outcomes within this cohort.
Investigators will develop a multi-centre prospective inception cohort of patients with
ASUC with homogeneously collected detailed longitudinal clinical, endoscopic, laboratory
and pharmacological data. This will facilitate development of risk prediction models in
ASUC helping early risk stratification and supporting optimized medical and surgical
algorithms in ASUC. The study will also facilitate development of a learning network in
participating centres to improve quality of care.