Elderly Patients with Moderate-To-Severe Ulcerative Colitis Are More Likely to Have Treatment Failure and Adverse Outcome

Abstract

<b><i>Background and Aim:</i></b> The aim of this study was to compare therapeutic responses and prognosis between elderly and nonelderly ulcerative colitis (UC) patients with moderate-to-severe activity. <b><i>Methods:</i></b> 148 UC patients with moderate-to-severe activity hospitalized between 2000 and 2019 were enrolled consecutively, including 74 patients with the age of diagnosis over 60 years and 74 patients diagnosed less than 60 years. Patients were matched by gender, duration (±15%), disease activity, and admission time (±1 year). They were followed up until the latest medical record or December 2019. The primary outcome was UC-related colectomy or death. <b><i>Results:</i></b> 148 patients were followed over median 37.5 months. For steroid use, 76.8% of elderly UC patients were responsive, lower than that in adult group (85.7%). A decreased level of clinical activity index (2.0 [−1.5 to 4.00] vs. 6.0 [3.0–8.0], <i>p</i> &#x3c; 0.001), reduction of C-reactive protein (23.9 [3.5–65.5] vs. 27.8 [9.7–58.1] mg/L), and erythrocyte sedimentation rate (9.0 [−1.3 to 30.5] vs. 15.5 [3.8–36.5] mm/h) at 4 weeks after steroid induction was less obvious in the elderly. More elderly patients manifested steroid dependence and resistance. 28.4% of elderly UC patients took colectomy, remarkably more than adult patients (12.2%), which also occurred earlier (8.0 [0.5–44.75] vs. 39.5 [12–57.38] months, <i>p</i> = 0.001). Aging (hazard ratio [HR] 2.868, 95% confidence interval [CI]: 1.290–6.375, <i>p</i> = 0.01), male, steroid resistance, and occurrence of complications were independently related to colectomy. The rate of serious infections was significantly higher in the elderly (55.4% vs. 35.1%, <i>p</i> = 0.013), mainly including cytomegalovirus infection, bacterial infection, and extraintestinal infection. Aging (odds ratio [OR] 2.774, 95% CI: 1.355–5.675, <i>p</i> = 0.015), extensive colonic involvement, steroid resistance, and biologics usage were independently associated with a high risk of concomitant infections. <b><i>Conclusion:</i></b> Elderly patients with moderate-to-severe UC experienced more treatment failure and increased risk of UC-related colectomy, mortality, and severe infections, predicting demand for more strict and individualized management.