A Comparison of Outcomes for Acute Ulcerative Colitis Flares Based on the Initial Glucocorticoid Regimen Measured Against Disease Activity and Severity.

BACKGROUND: Ulcerative colitis (UC) is a chronic inflammatory condition characterized by mucosal inflammation extending from the rectum proximally. Acute flares are traditionally managed with glucocorticoid (GC) therapy, but optimal dosing regimens remain undefined across professional societies. This study aimed to compare outcomes associated with different initial GC regimens (low, medium, high) for hospitalized patients with acute UC flares and to determine if outcomes vary based on disease activity and severity. METHODS: We conducted a retrospective chart review of hospitalized patients (age ≥18) diagnosed with UC (ICD-10 K.51) who received steroid therapy between January 2016 and November 2024. Primary outcomes included treatment escalation/improvement, changes in inflammatory markers (ESR, CRP), length of stay, colectomy rates during the index admission, and 30-day readmission. Analyses included binary logistic regression, Kruskal-Wallis tests, and negative binomial regression. RESULTS: Among 2,481 patients (mean age 44.8±18.5 years, 49.1% female), the initial regimen was significantly associated with treatment trajectory. Patients starting on low regimens were 1.32 times more likely to require escalation than those on medium regimens (p=0.05). Patients starting on high regimens were 3.43 times more likely to improve compared to medium regimens (p<0.0001). Length of stay was significantly associated with the initial regimen (p=0.05), with high regimens associated with shorter stays compared to low regimens. Changes in inflammatory markers were similar across all three regimen groups. The initial regimen was not significantly associated with colectomy rates or 30-day readmissions. CONCLUSION: The initial GC regimen choice influences treatment trajectory and length of stay for acute UC flares, with higher initial doses associated with improved outcomes for certain metrics. These findings provide evidence to guide clinical decision-making when selecting initial GC regimens for hospitalized patients with acute UC.