Abstract Background Despite advances in biologics a subgroup of ulcerative colitis (UC) patients still progress to colectomy. Real-world predictors of colectomy remain insufficiently defined. Methods We retrospectively analysed 436 UC patients with complete colectomy information (29 colectomy; 6%). Demographic, clinical and laboratory variables were extracted from electronic records. An additional registry of 104 steroid-refractory or steroid-dependent UC patients treated with biologics or JAK inhibitors was used to characterise the severe-disease subset.Univariate and multivariate logistic regression evaluated predictors of colectomy, including age, CRP at diagnosis, albumin and diagnosis-to-first-biologic interval. Results Median CRP at diagnosis was 17 mg/L in the colectomy group vs 4.5 mg/L in non-colectomy patients, and last-follow-up CRP was 8 mg/L vs 2 mg/L, respectively. Median age (57 vs 53 years) and albumin (4.3 vs 4.0 g/dL) were comparable.Higher CRP at diagnosis showed a trend toward increased colectomy risk (OR ≈3.2 per 10 mg/L, 95% CI 0.64–15.9; p = 0.17). Age, albumin and diagnosis-to-biologic interval were not significantly associated with colectomy. In a simple two-variable model including age and CRP at diagnosis, the effect size for CRP remained similar, whereas age was not independently associated with colectomy. Patterns of JAK inhibitors,anti-TNF, vedolizumab and ustekinumab exposure did not differ significantly between groups. Conclusion In this real-world cohort, baseline inflammatory burden,particularly higher CRP at diagnosis,was the only variable demonstrating a numerical trend toward colectomy, while age, albumin and treatment delay were not predictive. This pattern is consistent with existing literature highlighting inflammatory biomarkers as key drivers of surgical risk in UC and underscores the need for prospective biomarker-based prediction models. Conflict of interest: Ms. Dağcı, Gizem: No conflict of interest Yağlı, Mehmet Akif: No conflict of interest Telli, Pelin: No conflict of interest Gurbanov, Asim: No conflict of interest Agargun, Besim Fazil: No conflict of interest Genc Ulucecen, Sezen: No conflict of interest Cavus, Bilger: No conflict of interest Ormeci Çifcibaşi, Asli: No conflict of interest Demir, Kadir: No conflict of interest Besisik, Fatih: No conflict of interest Kaymakoglu, Sabahattin: No conflict of interest Akyüz, Filiz: No conflict of interest
Dağcı et al. (Thu,) studied this question.