Boyd Taylor, Araka Elizabeth Bonareri, Kochar Bharati, Ananthakrishnan Ashwin N
Harvard Medical School, Harvard University, Boston, MA, USA.
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
J Crohns Colitis. 2024 Apr 23;18(4):570-577. doi: 10.1093/ecco-jcc/jjad183.
Older adults with ulcerative colitis [UC] have greater morbidity than younger adults. The goal of this study was to investigate differences in the management and outcomes of older and younger patients hospitalised with severe UC.
We conducted a retrospective cohort study of patients hospitalised for acute severe ulcerative colitis requiring intravenous steroids. We compared outcomes of adults aged ≥65 years with outcomes of younger patients. Primary study outcomes included frequency and timing of medical and surgical rescue therapy during the hospitalisation, postoperative complications, frailty, and mortality outcomes up to 1 year following the hospitalisation.
Our cohort included 63 older adults [≥65 years] and 137 younger adults [14-64 years]. Despite similar disease severity at hospitalisation, older adults were half as likely to receive medical rescue therapy (odds ratio 0.45, 95% confidence interval [CI] 0.22-0.91). This difference was more striking among the frailest older adults. Older patients were similarly likely to undergo surgery but were more likely to undergo urgent or emergent procedures [50%] compared with younger patients [13%] [p <0.004]. The fraction of older adults at high risk for frailty increased from 33% pre-hospitalisation to 42% post-hospitalisation. Nearly one-third [27.8%] of older adults died within 1 year of hospitalisation, with half the deaths among older adults being attributable to UC or complications of UC.
In comparison with younger patients, older adults had lower frequency use of medical rescue therapy, higher rates of emergency surgery, and increased mortality within 1 year. Further research is needed to optimise care pathways in this population.
患有溃疡性结肠炎（UC）的老年人比年轻人发病率更高。本研究的目的是调查因严重UC住院的老年患者和年轻患者在治疗管理及治疗结果上的差异。
我们对因急性重症溃疡性结肠炎需静脉注射类固醇而住院的患者进行了一项回顾性队列研究。我们比较了年龄≥65岁的成年人与年轻患者的治疗结果。主要研究结果包括住院期间药物和手术抢救治疗的频率及时间、术后并发症、虚弱情况以及住院后1年内的死亡率。
我们的队列包括63名老年人（≥65岁）和137名年轻人（14 - 64岁）。尽管住院时疾病严重程度相似，但老年人接受药物抢救治疗的可能性仅为年轻人的一半（比值比0.45，95%置信区间[CI] 0.22 - 0.91）。这种差异在最虚弱的老年人中更为明显。老年患者接受手术的可能性与年轻患者相似，但与年轻患者（13%）相比，更有可能接受紧急或急诊手术（50%）[p < 0.004]。有虚弱高风险的老年人比例从住院前的33%增加到住院后的42%。近三分之一（27.8%）的老年人在住院1年内死亡，其中一半老年人的死亡归因于UC或UC并发症。
与年轻患者相比，老年人药物抢救治疗的使用频率较低、急诊手术率较高且1年内死亡率增加。需要进一步研究以优化该人群的护理路径。
