The use of a segmental endoscopic score may improve the prediction of clinical outcomes in acute severe ulcerative colitis
2016
Background: Acute severe colitis (ASC) remains a challenging
complication of ulcerative colitis. The early identification of patients
who will not respond to optimal therapy is warranted. Increasing
evidence suggests that endoscopy may play a role in predicting
important outcomes in acute severe colitis.
Methods: The endoscopic activity of consecutive patients with
acute severe colitis was evaluated using the Mayo endoscopic sub-score
(Mayo) and the ulcerative colitis endoscopic index of severity (UCEIS).
Two segmental indexes were also produced by summing the scores
of the rectum and sigmoid (seg-Mayo and seg-UCEIS, respectively).
Endpoints included the need for salvage therapy with infliximab or
cyclosporine, refractoriness to corticosteroids, and colectomy.
Results: Of one hundred and eight patients enrolled in the
study, 60 (55.6%) were male; with a median age of 34.5 years (range
15-80). All patients received intravenous steroids. Fifty-nine patients
(55.6%) showed an incomplete or absent response to steroids,
35 patients (34.3%) received salvage therapy with infliximab or
cyclosporine and 38 patients (33.3%) were colectomized during the
index hospitalization or within the first year of follow-up. All scores
were able to predict the need for surgery, but only the seg-UCEIS
significantly predicted refractoriness to steroids.
Conclusions: There was a strong correlation between
endoscopic severity and unfavorable outcomes. The UCEIS
outperformed the Mayo endoscopic sub-score in all important
outcomes. Segmental scoring further improved the performance
of the UCEIS.
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