P388 Response to IV steroid therapy in acute severe ulcerative colitis (ASUC) is not altered by admission to a tertiary referral centre: The NHS Lothian experience

• Published in: Journal of Crohn's and colitis 2018-01, Vol.12 (supplement_1), p.S300-S300
• Main Authors: Manship, T, Grant, R, Jagger, F, Lynch, R, Lees, C, Satsangi, J, Arnott, I
• Format: Article
• Language: English
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjx180.515

Abstract Background First-line treatment for ASUC with IV steroids is routinely given in UK hospitals. We sought to establish if initial treatment in a tertiary referral centre affected outcome. To this end we examined all admissions with ASUC within Lothian and compared outcomes between those initially treated at the tertiary referral centre: Western General Hospital (WGH) and those treated at the other two acute hospitals in the health trust: Royal Infirmary of Edinburgh (RIE) and St. John’s Hospital (SJH). We assessed both response to steroids and second-line medical therapy but also the likelihood of requiring surgery during the index admission. Methods Admissions to NHS Lothian were identified using the ICD-10 code K51 between November 2013 and November 2016. If a patient was admitted more than once during this time only the first admission was used. 159 patients were included. 105 (105/159; 66.0%) were admitted to WGH. 14 (14/159; 8.8%) were admitted to RIE and 40 (40/159; 25.2%) were admitted to SJH. Female:male split was 60 (37.7%):99 (62.3%). Average age at admission was 41.7 years (range 16.3–86.75). Results 71.4% (75/105) were successfully treated with IV steroids at WGH compared with 63.0% (34/54) who were successfully treated at RIE and SJH (p = 0.364; OR = 1.471). 37.0% (20/54) of patients treated for ASUC at the other hospitals in NHS Lothian required transfer to WGH for further management. There was wide variation in the proportion of ASUC patients referred from the two referring hospitals: 45% (SJH, 18/40) and 14.2% (RIE, 2/14). There was no significant difference in the proportion of patients requiring medical rescue therapy (Infliximab or Ciclosporin) when comparing those admitted to WGH 23.8% (25/105) and those admitted to RIE and SJH 33.3% (18/54) (p = 0.1412; OR = 0.625). Of those requiring second line medical therapy 48.0% (12/25) responded in the tertiary centre compared with 50.0% (9/18) in those admitted to other hospitals, and therefore did not require surgery (p = 0.6609; OR = 0.923). At WGH 16.7% (5/30) required surgery after failing IV steroids without being given second line medical therapy. Compared with 10% (2/20) of those transferred from surrounding hospitals (p = 0.8029; OR = 1.8). Conclusions In Lothian, although there is no statistical difference in response to IV steroids whether treatment was started in a tertiary referral centre or not, there was a trend towards a greater success at WGH. There was no statistical dif