Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery.
BACKGROUND
The failure rate of medical therapy in severe ulcerative colitis is high. A risk index, to aid the identification of patients of not responding at an early stage to intravenous corticosteroid therapy, would be useful to facilitate second-line treatment or surgery.


METHODS
We recruited 167 consecutive patients with severe ulcerative colitis between January 1995 and March 2002; and employed multiple logistic regression to analyse parameters within the first 3 days of medical therapy. We applied statistical modelling to formulate a risk score according to the likelihood of medical failure.


RESULTS
Sixty-seven (40%) patients failed to respond to medical therapy. Multiple logistic regression analysis identified mean stool frequency and colonic dilatation within the first 3 days and hypoalbuminaemia as independent predictors of outcome (P < 0.001, 0.001 and 0.002 respectively). A numerical risk score was formulated based on these variables. Patients with scores of 0-1, 2-3 and > or =4 had a medical therapy failure rate of 11%, 43% and 85% respectively. Receiver-operator characteristic analysis of this score yielded area under curve of 0.88, with a sensitivity of 85% and specificity of 75% using score > or =4 in predicting non-response.


CONCLUSIONS
This risk score allows the early identification of patients with severe ulcerative colitis who would be suitable for second-line medical therapy or surgery.
Ho
G T
GT
University Department of Gastroenterology, Western General Hospital, Edinburgh EH4 2XU, Scotland, UK. gho@ed.ac.uk
Mowat
C
C
Goddard
C J R
CJ
Fennell
J M
JM
Shah
N B
NB
Prescott
R J
RJ
Satsangi
J
J
D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D017211:Treatment Failure
D007166:Immunosuppressive Agents; D016572:Cyclosporine