Lin, Wei-ChenWei-ChenLinLin, Chun-ChiChun-ChiLinHsu, Wen-HungWen-HungHsuChiang, Feng-FanFeng-FanChiangChang, Chen-WangChen-WangChangHsu, Tzu-ChiTzu-ChiHsuWu, Deng-ChyangDeng-ChyangWuWang, Horng-YuanHorng-YuanWangJAU-MIN WONGSHU-CHEN WEI2026-04-272026-04-272026-01https://scholars.lib.ntu.edu.tw/handle/123456789/737604Background/Aims: Data from Asia regarding the short-term and long-term outcomes for acute severe ulcerative colitis (ASUC) are limited. We assessed the outcomes of ASUC, identified the risk factors for colectomy, and compared colectomy rates between the pre-biologics and post-biologics eras in Taiwan. Methods: The patients with an ASUC diagnosis between January 2013 and March 2022 at 5 tertiary medical centers were retrospectively analyzed. Results: In total, 98 patients were enrolled, with 68.4% diagnosed in the post-biologics era. In 78.6% of the ASUC patients initially received intravenous steroid therapy, for which the success rate was 74.1%. As for rescue therapy, 15 patients (93.8%) received biologics and 1 (6.3%) received cyclosporin. Biologics rescue therapy had a 93.3% success rate. One (1%) mortality due to septic shock occurred. The colectomy rate for index ASUC admission was 11.2%. Patients receiving colectomy were predominantly male (P=0.012) and at older age (P=0.016). Higher C-reactive protein (P=0.035), lower albumin (P=0.017), and hemoglobin (P=0.023) levels were associated with colectomy risk. During a median follow-up of 24 months, 13 patients (15.1%) had recurrent ASUC and 23.1% of patients received colectomy. The accumulated colectomy rate at 3 years did not differ between the pre- and post-biologics eras (16.1% vs. 13.4%, P=0.270). Conclusions: This is the first Asian study on ASUC to compare colectomy rates between the pre-biologics and post-biologics eras, revealing no significant difference. The recurrent ASUC had a higher colectomy rate than the index ASUC. (Intest Res 2026;24:117-128).enBiologicsColectomyRisk factorsUlcerative colitisjournal article10.5217/ir.2024.0011239849950