Corticosteroid therapy in ulcerative colitis: Clinical response and predictors

Table 1 Demographic, clinical, laboratory characteristics and auxiliary medication in 101 ulcerative colitis cases before initial administration of corticosteroid n (%)

	Prolonged response	Dependence	Refractoriness	Total
Cases	42	50	9	101
Female	24 (57.1)	22 (44.0)	2 (22.8)	48 (47.5)
Age (≥ 30 yr)	39 (92.8)	41 (82.0)	6 (66.7)	85 (84.2)
Disease duration (≥ 5 yr)	12 (29.3)	15 (31.9)	2 (22.2)	29 (33.3)
Relapse frequency (> 3/yr)	2 (5.9)	4 (9.3)	0	6 (7.0)
Previous colectomy	4 (9.5)	3 (6.0)	1 (11.1)	8 (7.9)
UC location
Proctitis	7 (17.5)	6 (12.2)	2 (22.2)	15 (15.3)
Left-side colitis	5 (12.5)	9 (18.4)	1 (11.1)	15 (15.3)
Extensive colitis	28 (70.0)	34 (69.4)	6 (66.7)	68 (69.4)
Sutherland score
Mild (3-5)	2 (4.8)	2 (4.0)	1 (11.1)	5 (5.0)
Moderate (6-10)	21 (50.0)	25 (50.0)	2 (22.2)	48 (47.5)
Severe (11-12)	19 (45.2)	23 (46.0)	6 (66.7)	48 (47.5)
Heart rate (≥ 90/min)	8 (19.5)	18 (36.0)	5 (55.6)	31 (31.0)
Diarrhea ( ≤ 6/d)	14 (33.3)	25 (50.0)	4 (44.4)	43 (42.6)
Bloody stool	34 (80.1)	44 (88.0)	8 (88.9)	86 (85.1)
Mucus	34 (81.0)	39 (78.0)	6 (66.7)	79 (78.2)
Tenesmus	25 (59.5)	16 (32.0)	4 (44.4)	45 (44.6)
Abdominal pain	34 (81.0)	47 (94.0)	9 (100.0)	90 (89.1)
Abdominal distention	6 (14.3)	8 (16.0)	4 (44.4)	18 (17.8)
Weight loss	17 (40.5)	18 (36.0)	7 (77.8)	42 (41.6)
Fever	13 (31.0)	13 (26.0)	5 (55.6)	31 (30.7)
Extra-intestinal manifestation	6 (14.3)	7 (14.0)	2 (22.2)	15 (14.9)
Hemoglobin (< 12.0 mg/dL)	32 (76.2)	31 (62.0)	9 (100.0)	72 (71.3)
Leukocyte (4-10 × 109/L)	21 (50.0)	29 (58.0)	9 (100.0)	59 (58.4)
Neutrophil (50%-70%)	20 (47.6)	28 (56.0)	6 (66.7)	54 (53.5)
Platelet (> 300 × 1012/L)	26 (61.9)	26 (52.0)	4 (44.4)	56 (55.4)
Albumin (< 3.5 mg/dL)	27 (64.3)	27 (54.0)	5 (55.6)	59 (58.4)
K+ (< 3.5 mmol/L)	16 (15.8)	16 (32.0)	3 (33.3)	35 (34.7)
ESR (> 15 mm/h)	27 (64.3)	27 (54.0)	7 (77.8)	61 (60.4)
Auxiliary medication
None	2 (4.8)	7 (14.0)	1 (11.1)	10 (9.9)
Only SASP or 5-ASA (A)	32 (76.2)	29 (58.0)	5 (55.6)	66 (65.3)
Only immunosuppressant (B)	1 (2.4)	4 (8.0)	1 (11.1)	6 (5.9)
Only infliximab (C)	0	0	0	0
A + B	6 (14.3)	9 (18.0)	2 (22.2)	17 (16.8)
A + C	1 (2.4)	1 (2.0)	0	2 (2.0)

The demographic, clinical and laboratory characteristic were displayed respectively according to the cohorts of different corticosteroid response. The auxiliary medication after the start of corticosteroid treatment was also displayed. UC: Ulcerative colitis; ESR: Erythrocyte sediment rate; 5-ASA: 5-aminosalicylates; SASP: Sulfasalazine.

Table 2 Logistic regression analysis of risk factors for corticosteroid dependence before start of corticosteroid

	P value1		OR (95%CI)
	Univariate	Multivariate
Tenesmus	0.012	0.013	0.336 (0.147-0.768)
Anemia	0.041	0.338	0.576 (0.233-1.422)
Hypokalemic (< 3.0 mmol/L)	0.065	0.060	0.121 (0.014-1.028)
Diarrhea (> 6/d)	0.135
ESR (> 15 mm/h)	0.193
Weight loss	0.260
Tachycardia (≥ 90/min)	0.280
Hypoproteinemia (< 3.5 mg/dL)	0.373

¹Data with univariate P < 0.5 are not displayed. All the variables were statistically analyzed. In univariate analysis, tenesmus and anemia before start of corticosteroid treatment were related with corticosteroid dependence (P = 0.012, 0.041). All the variables with P < 0.100 were further analyzed by logistic regression. After multivariate analysis, tenesmus at baseline was found to be associated with corticosteroid dependence (OR = 0.336, 95%CI: 0.147-0.768; P = 0.013). ESR: Erythrocyte sediment rate.

Table 3 Logistic regression analysis of risk factors for corticosteroid refractoriness before start of corticosteroid

	P value1		OR (95%CI)
	Univariate	Multivariate
Weight loss	0.051	0.040	5.662 (1.111-28.857)
Abdominal distention	0.086	0.251	2.436 (0.601-9.882)
Fever	0.188
Tachycardia (≥ 90/min)	0.196
Age (< 30 yr)	0.253
ESR (> 15 mm/h)	0.277
Sutherland score (≥ 11)	0.392

¹Data with univariate P < 0.5 are not displayed. All the variables were statistically analyzed. In univariate analysis, no variables were related with corticosteroid refractoriness. All the variables with P < 0.100 were further analyzed by logistic regression. After multivariate analysis, weight loss at baseline was found to be associated with corticosteroid refractoriness (OR = 5.662; 95%CI: 1.111-28.857; P = 0.040). ESR: Erythrocyte sediment rate.

Table 4 Logistic regression analysis of risk factors for corticosteroid dependence at one month after start of corticosteroid

	P value1		OR (95%CI)
	Univariate	Multivariate
Sutherland score (≥ 6)	0.037	0.014	2.347 (0.935-5.890)
Abnormal neutrophil%	0.016	0.107	0.425 (0.168-1.075)
Weight loss	0.021	0.336	2.400 (0.839-6.866)
Mucus	0.096
Diarrhea (> 6/d)	0.136
Hypokalemic (< 3.5 mmol/L)	0.176
ESR (> 15 mm/h)	0.186
Bloody stool	0.343

¹Data with univariate P < 0.5 are not displayed. All the variables were statistically analyzed. In univariate analysis, Sutherland score (≥ 6), abnormal neutrophil% and weight loss after one month of corticosteroid treatment were related with corticosteroid dependence (P = 0.037, 0.016, 0.021). All the variables with P < 0.100 were further analyzed by logistic regression. After multivariate analysis, sustained high Sutherland score (≥ 6) after one-month treatment was found to be associated with corticosteroid dependence (OR = 2.347; 95%CI: 0.935-5.890; P = 0.014).

Table 5 Different studies for ulcerative colitis cases with initial corticosteroid treatment

	Current study	Chen et al[20]	Chow et al[21]	Faubion et al[25]	Tung et al[26]	Jeon et al[22]	Ho et al[17]
Area	Mainland China	Guangzhou	Hong Kong	Olmsted	Olmsted	Korea	UK
		(China)	(China)	(USA)	(USA)
Cases, n	101	81	95	63	14 ( ≤ 19 yr)	67.0	86
Date	2007-2011	2002-2010	1985-2007	1970-1993	1940-2001	1996-2010	1998-2003
Study type	Multi-center	Single-center	Single-center	Population-based	Population-based	Single-center	Single-center
Within 1 mo, %
Response	95	97.5	93.7	84	79	78.5	82
Non-response	5	2.5	6.3	16	21	19.7	25
Within 1 yr, %
Pronged response	41.6	67.1	46.3	49	57	46.3	55
CS dependence	49.5	32.9	47.4	22	14	42.6	17
Surgery	6.9	0	7.4	29	29	16.0	21

Part of the cases had previous use of corticosteroids. Different studies were conducted in different areas, dates and cohorts to evaluate corticosteroid response in ulcerative colitis according to the similar classification of corticosteroid response. CS: Corticosteroid.