Low Albumin Is Still a Significant Risk Factor for Surgery in Patients Admitted with Severe Ulcerative Colitis Flare

Introduction: About 15% patients with ulcerative colitis (UC) will develop an acute severe flare requiring hospitalization. Based on recent studies in the biologic era, it is estimated that rate of colectomy in such patients is about 10% during that hospitalization and 20% at the end of 2 years. Early studies showed that a low serum albumin may be a prognostic indicator of need for surgery, however further data showed a limited association. Our aim was to assess association of low albumin and a neutrophil bandemia in patients admitted with an acute flare of UC and undergoing surgery. Methods: We retrospectively reviewed charts of patients with UC followed at our center, in our database, and identified patients who were admitted with a flare of severe UC in the last 5 years. Their charts were reviewed to collect clinical, radiologic and laboratory data and patients were divided into 2 groups - cases, that included patients who underwent surgery during their admission with acute flare and controls who did not undergo surgery. The disease characteristics of these 2 groups were compared with specific focus on serum albumin < 2 gm/dL and presence of ≥ 20% neutrophil bandemia on their blood count during hospitalization being dependent variables and surgery being the outcome using a logistic regression model. Results: Out of 287 patients with UC we identified a total of 67 patients who were admitted with a flare of severe UC and 49 had complete data for inclusion in this analysis. Of these, 13 underwent colectomy. The mean age at diagnosis was 39.8 years (95% CI - 34.1 - 45.5 years), mean disease duration of 9.9 years (95% CI 6.8 - 13.1 years) and 51% of patients were male. All patients were on intravenous steroids for at least 3 days. On multivariate logistic regression analysis we found that albumin ≤ 2 gm/dL was significantly associated with risk of surgery (OR - 17.8, p = 0.005. CI 2.4 - 129) after correcting for age, gender, CRP level at admission, disease duration, number of hospitalizations. On correcting for biologic use, the OR for albumin ≤ 2 increased to 86. Bandemia of ≥ 20% was also associated with an increased risk of surgery (OR 3.3) although not statistically significant. Conclusion: Based on our analysis, albumin ≤ 2 gm/dL is significantly associated with a risk of requiring surgery in patients who are hospitalized with a flare of severe ulcerative colitis. The major limitations of this study are its retrospective nature and small sample size.