Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit

Summary Background Approximately one third of patients with acute severe ulcerative colitis (ASUC) fail response to steroids. Ciclosporin and anti‐TNFα are proven second‐line therapies, but evidence of their efficacy has come mainly from tertiary centres and/or selective clinical trial recruitment. Aim To assess ASUC outcomes in a large unselected cohort. Methods UK‐wide audits of IBD care were conducted in 2008 (209 hospital sites) and 2010 (198 hospital sites), covering >87% of admitting hospitals. Each site entered data from 20 consecutive UC admissions onto a web‐based proforma. Admissions included 852 (2008) and 984 (2010) with ASUC, accounting for 35% and 39% of UC admissions, respectively. Results ASUC in‐hospital mortality was 1.2% in 2008; 0.7% in 2010 (P = 0.22). Response to first‐line steroid therapy was 61% (2008); 58% (2010) and mortality was higher in non‐responders: 2008: 2.9% (9/315) vs. 0.19% (1/537; P