Which clinical and laboratory factors independently predict failure of medical therapy in patients with severe UC

What is known

- In an acute severe UC cohort, low day-one serum albumin was an independent predictor of steroid non-response. ¹ - A referenced score (ASUC score) combined oral steroid failure, albumin ≤ 30 g/L, and UCEIS ≥ 7 to predict need for rescue therapy. ¹ - A prospective study found clinical parameters and disease activity index predicted medical-treatment failure on multivariate analysis, whereas age, albumin, and FDP did not remain significant in that model. ² - Reviewed parameters proposed as predictors include younger age, fever, weight loss, persistent diarrhoea, bloody stools, CRP elevation, and extensive disease. ³

What is unknown / caveats

- Serum albumin was an independent predictor in one cohort ¹ but lost significance on multivariate analysis in another ² - Extensive/severe colitis at diagnosis predicted relapse but not later colectomy in one cohort ⁴ - Mostly retrospective/observational single-cohort data - Review notes individual parameters have insufficient validity to use alone ³ - Authors state findings need validation in larger prospective cohorts ¹ - The exact set of independent predictors varies between cohorts and predictive indices, so no single validated variable set emerges.

## References

1. [No authors listed]. Evaluation of Acute Severe Ulcerative Colitis Predictors for Steroid Therapy Refractoriness. Dig Dis Sci. 2025;70:2414-2425. PMID: 40188169.

2. Kumar S, Ghoshal UC, Aggarwal R, Saraswat VA, Choudhuri G. Severe ulcerative colitis: prospective study of parameters determining outcome. J Gastroenterol Hepatol. 2004;19:1247-52. PMID: 15482530.

3. [No authors listed]. Validity of simple mucosal biopsy criteria combined with endoscopy predicting patients with ulcerative colitis ultimately requiring surgery: a multicenter study. Scand J Gastroenterol. 2003;38:594-8. PMID: 12825866.

4. Shiga H, Takagi S, Inoue R, Kinouchi Y, Ohkubo T, Takahashi S, Negoro K, Yokoyama H, Kato S, Fukushima K, Hiwatashi N, Shimosegawa T. What determines the later clinical course of patients who do not undergo colectomy at the first attack? A Japanese cohort study on ulcerative colitis. Digestion. 2010;81:104-12. PMID: 20068310.

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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._