Day 3 CRP Levels May Predict Colectomy Risk in Patients With Severe Ulcerative Colitis
Using a dynamic approach to inflammation monitoring, researchers have found that C-reactive protein (CRP) trends—particularly by Day 3 of hospitalization—may help predict which patients with acute severe ulcerative colitis (ASUC) are most likely to require colectomy. These findings, presented at DDW 2025 in an abstract spanning a 10-year cohort study, challenge the long-standing Oxford (Travis) Index by highlighting the limitations of using a static CRP threshold across all patients.
The Oxford Index, established in 1996, uses stool frequency and a CRP cutoff of >45 mg/L after 72 hours of steroid treatment to estimate colectomy risk. However, this approach does not account for individual variability in baseline CRP levels, prior steroid exposure, or response trajectories. To address this, researchers analyzed longitudinal data from 880 adults hospitalized with ASUC between 2014 and 2024 at a single academic center.
Using latent class analysis, they stratified patients into four CRP subgroups at admission: non-producers (<1.0 mg/dL), low (1.0–3.3 mg/dL), intermediate (3.4–9.4 mg/dL), and high (≥9.5 mg/dL). The strongest predictors of 90-day colectomy were observed only in the high CRP subgroup. Specifically, an elevated absolute CRP on Day 3 (OR 1.07; 95% CI, 1.02–1.13; p=0.008) and a slower decline in CRP from Day 0 to Day 3 (OR 1.16; 95% CI, 1.02–1.34) were significantly associated with increased colectomy risk.
Conversely, these associations were not seen in patients with low or intermediate CRP levels, suggesting that fixed thresholds may overestimate risk in certain subpopulations. The study underscores the importance of a tailored approach in managing ASUC, where trends in inflammatory markers may offer more precise prognostic insight than static values.
"These data suggest that using an absolute CRP cutoff to determine the risk of requiring colectomy or second-line therapy may not be appropriate for all patients with ASUC," conclude the study authors.
Omar YA, Tedesco NR, Gu P, et al. Using longitudinal C-reactive protein measurements throughout hospitalization to assess colectomy risk in patients with acute severe ulcerative colitis. Abstract Mo1935 presented at: Digestive Disease Week. May 3-6. 2025; San Diego, CA.
