S1937 Clinical and Nutritional Predictors of Hospital Length of Stay in Patients With Acute Severe Ulcerative Colitis

Introduction: Up to 25% of patients with ulcerative colitis will need admission for a severe flare. Acute severe ulcerative colitis (ASUC) can lead to prolonged hospital length of stay (LOS), which results in increased healthcare utilization, missed work days, and adverse clinical outcomes. Identifying clinical and nutritional markers associated with extended hospitalization may help guide early interventions and discharge planning. Methods: We conducted a single-center retrospective cohort study of patients admitted with ASUC from 1/1/15-8/30/23. LOS was analyzed both as a continuous variable, and a categorical variable if LOS ≥10 days. Univariate analysis identified candidate predictors. Stepwise linear regression was performed for log-transformed LOS, and logistic regression was used to identify predictors of LOS ≥10 days. Covariates included demographics, disease activity, nutritional status, and treatment-related factors. Results: A total of 216 patients were included in the cohort. The median LOS was 5 days (IQR 4–8); 18.6% (n = 40) of patients had prolonged stays. Compared to shorter stays, patients with LOS ≥10 days had lower albumin (3.1 vs 3.5 g/dL, P < 0.001), lower hemoglobin (10.9 vs 11.8 g/dL, P = 0.048), and higher rates of anemia (P = 0.032). Nutrition consult (87.2% vs 33.3%, P < 0.001), TPN use (23.1% vs 1.1%, P < 0.001), and IFX rescue (55.0% vs 34.1%, P = 0.014) were more common in those with prolonged LOS. In multivariable linear regression, low albumin (β = 0.24, P = 0.009), need for nutrition consult (β = 0.46, P < 0.001), and TPN use (β = 0.81, P < 0.001) were independently associated with increased LOS. In logistic regression for LOS ≥10 days, low albumin (OR 4.0, 95% CI 1.38–11.66, P = 0.011), anemia (OR 4.6, P = 0.030), nutrition consult (OR 15.1, P < 0.001), and TPN (OR 16.4, P = 0.003) were significant predictors. Conclusion: This study highlights key clinical and nutritional predictors of prolonged hospitalization in patients with ASUC. Lower hemoglobin and albumin levels, and the need for nutrition consultation and TPN, reflect more severe disease and were strongly associated with longer hospitalizations. These findings support early identification and triage of high-risk patients, integration of nutritional support early in the admission, and timely escalation to biologic therapy to reduce LOS.