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Purpose <p>Predicting outcomes in acute severe ulcerative colitis (ASUC) is challenging. Data suggest visceral adiposity may negatively impact ulcerative colitis outcomes. We aimed to evaluate the impact of visceral adiposity and sarcopenia on ASUC outcomes.</p> Methods <p>Patients hospitalized for ASUC with available abdominopelvic CT imaging within 3&#xa0;months of admission were retrospectively reviewed. Automated segmentation of subcutaneous adipose tissue (SAT) and visceral adipose tissue(VAT) at the third lumbar vertebrae was performed and reviewed by expert radiologists in Visage AI Accelerator.&#xa0;The primary outcome was colectomy during index hospitalization based on quartiles of VAT and visceral fat index (VFI) (VAT:SAT), sarcopenia, and sarcopenic obesity. Secondary outcomes aimed at assessing response to intravenous corticosteroids (IVCS) and infliximab (IFX). Univariate and multivariate associations with the risk of colectomy at index hospitalization were examined using logistic regression models.</p> Results <p>A total of 90 patients (64.4% male, median age 36.5&#xa0;years) were identified. During the index hospitalization, 32 patients (35.6%) required colectomy. Response to IVCS and IFX was seen in 54.2% (45/86) and 66.7% (18/27) patients, respectively. There were no significant differences in the risk of colectomy, response to IVCS or IFX based on VAT area or VFI. Sarcopenia was associated with a reduced likelihood of IVCS response (HR 0.33; 95% CI 0.11–0.97; <i>p</i> = 0.045). Prior advanced therapy exposure was associated with an increased risk of colectomy (HR 7.95; <i>p</i> &lt; 0.001) and decreased response to IVCS (HR 0.35; <i>p</i> = 0.041) on multivariate analysis and decreased response to IFX on univariate analyses (OR 0.16; <i>p</i> = 0.072).</p> Conclusion <p>In this cohort, neither visceral adiposity nor sarcopenia significantly impacted the colectomy risk, while sarcopenia was associated with a reduced likelihood of corticosteroid response. Prior advanced therapy exposure negatively impacted all outcomes.</p>

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Evaluating the Impact of Visceral Adiposity and Sarcopenia on Outcomes in Hospitalized Patients with Acute Severe Ulcerative Colitis

  • 期刊论文

  • 发表日期：

    2025年12月19日

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  • Prajith Raj Ramesh,
  • Robert P. Hartman,
  • William S. Harmsen,
  • Jason Klug,
  • Joao Miranda,
  • Abhinav Vasudevan,
  • Edward V. Loftus Jr.,
  • John V. Thomas,
  • Amanda M. Johnson

摘要

Purpose

Predicting outcomes in acute severe ulcerative colitis (ASUC) is challenging. Data suggest visceral adiposity may negatively impact ulcerative colitis outcomes. We aimed to evaluate the impact of visceral adiposity and sarcopenia on ASUC outcomes.

Methods

Patients hospitalized for ASUC with available abdominopelvic CT imaging within 3 months of admission were retrospectively reviewed. Automated segmentation of subcutaneous adipose tissue (SAT) and visceral adipose tissue(VAT) at the third lumbar vertebrae was performed and reviewed by expert radiologists in Visage AI Accelerator. The primary outcome was colectomy during index hospitalization based on quartiles of VAT and visceral fat index (VFI) (VAT:SAT), sarcopenia, and sarcopenic obesity. Secondary outcomes aimed at assessing response to intravenous corticosteroids (IVCS) and infliximab (IFX). Univariate and multivariate associations with the risk of colectomy at index hospitalization were examined using logistic regression models.

Results

A total of 90 patients (64.4% male, median age 36.5 years) were identified. During the index hospitalization, 32 patients (35.6%) required colectomy. Response to IVCS and IFX was seen in 54.2% (45/86) and 66.7% (18/27) patients, respectively. There were no significant differences in the risk of colectomy, response to IVCS or IFX based on VAT area or VFI. Sarcopenia was associated with a reduced likelihood of IVCS response (HR 0.33; 95% CI 0.11–0.97; p = 0.045). Prior advanced therapy exposure was associated with an increased risk of colectomy (HR 7.95; p < 0.001) and decreased response to IVCS (HR 0.35; p = 0.041) on multivariate analysis and decreased response to IFX on univariate analyses (OR 0.16; p = 0.072).

Conclusion

In this cohort, neither visceral adiposity nor sarcopenia significantly impacted the colectomy risk, while sarcopenia was associated with a reduced likelihood of corticosteroid response. Prior advanced therapy exposure negatively impacted all outcomes.