Recommendations on the Appropriate Management of Steroids and Discharge Planning During and After Hospital Admission for Moderate-Severe Ulcerative Colitis: Results of a RAND Appropriateness Panel.
Recommendations on the Appropriate Management of Steroids and Discharge Planning During and After Hospital Admission for Moderate-Severe Ulcerative Colitis: Results of a RAND Appropriateness Panel.
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DOI：
10.14309/ajg.0000000000001775
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发表时间：
2022-08-01
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对于因中重度发作而住院的溃疡性结肠炎 (UC) 患者的出院后护理指导有限。 RAND 方法用于确定住院患者和出院后类固醇剂量、出院标准、随访以及出院后生物或小分子启动的适当性。文献综述为小组投票提供了信息，投票在主持的虚拟会议之前和之后的两轮中以匿名方式进行。甲泼尼龙 40-60mg 每 24 小时静脉注射或氢化可的松 100mg 静脉注射每日 3 次适合住院治疗，如果不能耐受更高剂量，甲泼尼龙 40mg 较为合适。一旦直肠出血消失（Mayo 子评分 0-1）和/或大便频率恢复到基线频率和形式（Mayo 子评分 0-1），就可以让患者出院。住院观察24小时后，出院时宜服用40mg泼尼松，以确保出院前病情稳定。对于出院时使用类固醇但未开始院内生物或小分子治疗的患者，对于未接受过抗 TNF 治疗的患者，出院后开始抗 TNF 治疗是适当的。对于暴露于抗 TNF 药物的患者，适合所有患者开始使用维多珠单抗或乌特克单抗，对于不良事件风险较低的患者开始使用托法替布。出院后2周内进行临床随访，4-6个月内进行下消化道内镜检查为宜。我们为因中重度发作而住院的 UC 患者的住院和出院后管理提供建议。
Limited guidance exists for the post-discharge care of ulcerative colitis (UC) patients hospitalized for moderate-severe flares. RAND methodology was used to establish appropriateness of inpatient and post-discharge steroid dosing, discharge criteria, follow-up, and post-discharge biologic or small molecule initiation. A literature review informed the panels voting, which occurred anonymously during two rounds before and after a moderated virtual session. Methylprednisolone 40–60mg IV every 24 hours or hydrocortisone 100mg IV three times daily are appropriate for inpatient management, with methylprednisolone 40mg being appropriate if intolerant of higher doses. It is appropriate to discharge patients once rectal bleeding has resolved (Mayo sub score 0–1) and/or stool frequency has returned to baseline frequency and form (Mayo sub score 0–1). It is appropriate to discharge patients on 40mg of prednisone after observing patients for 24 hours in-hospital to ensure stability prior to discharge. For patients being discharged on steroids without in-hospital biologic or small molecule therapy initiation, it is appropriate to start anti-TNF therapy after discharge for anti-TNF naïve patients. For anti-TNF exposed patients it is appropriate to start vedolizumab or ustekinumab for all patients, and tofacitinib for those with a low risk of adverse events. It is appropriate to follow up patients clinically within 2 weeks, and with lower endoscopy within 4–6 months after discharge. We provide recommendations on the inpatient and post-discharge management of UC patients hospitalized for moderate-severe flares.