What clinical parameters define steroid‑refractory ASUC
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steroid-refractory ASUC is defined by failure to respond to intravenous corticosteroids assessed on day 3 of admission, using stool frequency and c-reactive protein: >8 stools/day, or 3–8 stools/day together with a CRP >45 mg/L, predicts an ~85% colectomy rate 1,2. this is applied to patients meeting truelove and witts' criteria for acute severe colitis (≥6 bloody stools/day plus fever, tachycardia, anemia, or elevated ESR) who fail first-line iv steroids 1. 1–4
What is known: - The day-3 stool-frequency and CRP algorithm is one of the most useful prognostic tools for predicting steroid response in hospitalized acute UC. 2 - About 30–40% (roughly one-third) of severe UC patients are steroid-refractory, requiring rescue therapy or colectomy. 1,3,4 - Approximately two-thirds of acute severe attacks respond to first-line intravenous corticosteroids; the remainder are refractory. 4
What is unknown / caveats: - Excerpts describe one day-3 threshold algorithm; other composite indices (e.g., day-1/day-3 indices) are mentioned but their specific cutoffs are not detailed in the retrieved text - The excerpts specify the Oxford-type day-3 CRP/stool thresholds but do not enumerate all validated predictive indices or their exact parameters.
## References
1. Luo CX, Wen ZH, Zhen Y, Wang ZJ, Mu JX, Zhu M, Ouyang Q, Zhang H. Chinese research into severe ulcerative colitis has increased in quantity and complexity. World J Clin Cases. 2018;6:35-43. PMID: 29564356.
2. Doherty GA, Cheifetz AS. Management of acute severe ulcerative colitis. Expert Rev Gastroenterol Hepatol. 2009;3:395-405. PMID: 19673626.
3. Gisbert JP, García MJ, Chaparro M. Rescue Therapies for Steroid-refractory Acute Severe Ulcerative Colitis: A Review. J Crohns Colitis. 2023. PMID: 36652279.
4. Hare NC, Arnott ID, Satsangi J. Therapeutic options in acute severe ulcerative colitis. Expert Rev Gastroenterol Hepatol. 2008;2:357-70. PMID: 19072385.
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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._
Reviewer notes