title: An optimized patient-reported ulcerative colitis disease activity measure derived from the Mayo score and the simple clinical colitis activity index.
abstract: BACKGROUND
  There is a need for simple, noninvasive patient-driven disease assessment instruments in ulcerative colitis (UC). We sought to further assess and refine the previous described 6-point Mayo score.
  
  
  METHODS
  A cross-sectional study of 282 UC patients was conducted assessing the correlation of the 2 patient-reported Mayo score components (6-point Mayo score) with the simple clinical colitis activity index (SCCAI) and a single Likert scale of patient-reported disease activity. Spearman's correlation, sensitivity, specificity, and area under the receiver operating curves (AUC) were calculated. A separate validation study in 59 UC patients was also conducted.
  
  
  RESULTS
  Participants predominantly had long-standing disease (83%) and were in self-reported remission (63%). The 6-point Mayo score correlated well with the SCCAI (rho = 0.71; P < 0.0001) and patient-reported disease activity (rho = 0.65; P < 0.0001). Using a cutpoint of 1.5, the 6-point Mayo score had 83% sensitivity and 72% specificity for patient-defined remission, and 89% sensitivity and 67% specificity for SCCAI-defined remission (score, <2.5). The 6-point Mayo score and SCCAI had similar accuracy of predicting patient-defined remission (AUC = 0.84 and 0.87, respectively). Addition of the SCCAI general well-being question to the 6-point Mayo improved the predictive ability for patient-defined remission; and a new weighted score had an AUC of 0.89 in the development cohort and 0.93 in the validation cohort. The optimal cutpoint was 1.6.
  
  
  CONCLUSIONS
  The patient-reported UC severity index that includes stool frequency, bleeding, and general well-being accurately measures clinical disease activity without requiring direct physician contact.
authors.affiliation: *Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania; †Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania; and ‡Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Bewtra
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Brensinger
authors.forename: Vesselin T
authors.initials: VT
authors.lastname: Tomov
authors.forename: Tram B
authors.initials: TB
authors.lastname: Hoang
authors.forename: Carly E
authors.initials: CE
authors.lastname: Sokach
authors.forename: Corey A
authors.initials: CA
authors.lastname: Siegel
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003672:Defecation; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000503:physiopathology; D006306:Health Surveys / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011177:Postal Service; D011446:Prospective Studies; D012372:ROC Curve; D057566:Self Report / Q000592:standards*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index