title: Association between the ulcerative colitis endoscopic index of severity (UCEIS) and outcomes in acute severe ulcerative colitis.
abstract: BACKGROUND
  The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) accounts for 86% of the variance between observers in the overall assessment of endoscopic severity, but has not been correlated with outcomes.
  
  
  METHODS
  Consecutive cases of acute severe colitis (ASC) defined by Truelove and Witts (TW) criteria were retrospectively evaluated. Demographic details, number of TW criteria, prior medical therapy, UCEIS and inpatient medical therapy were recorded. Pre-specified (adverse) endpoints included rescue therapy, colectomy and readmission.
  
  
  RESULTS
  Eighty-nine patients, 48 (54%) male, mean age 38 years, all received intravenous hydrocortisone 400mg/d (median 5 days [range 1-11]). Median follow-up was 14 months (2-33). Forty-eight (54%) were diagnosed the year prior to or at the time of admission. Thirty-six (40%) required rescue therapy (infliximab 25/36, ciclosporin 12/36, one receiving both). Twenty-one (24%) underwent colectomy on the index admission (9/21) or during follow-up (12/21). Median UCEIS score (possible range 0-8) was 5 (3-8). UCEIS was higher in patients requiring rescue therapy or colectomy (median score 6 [range 4-8] versus 5/8 [3-8], both p < 0.005). For UCEIS ≥5, 27/54 (50%) required rescue therapy, compared with 9/33 (27%) for UCEIS ≤4 (p = 0.037). When UCEIS was ≥5, 18/54 (33%) came to colectomy during follow-up, compared with 3/33 (9%) with UCEIS ≤4. Of 14 patients with UCEIS 7 or 8, 11/14 needed rescue therapy and 13/14 met any adverse endpoint.
  
  
  CONCLUSIONS
  Endoscopic severity is associated with a worse outcome in ASC. When the UCEIS is ≥7 on admission, almost all patients will need treatment with infliximab or ciclosporin beyond steroids. This may mark a threshold for an early decision to use infliximab or ciclosporin.
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
authors.forename: Crispin
authors.initials: C
authors.lastname: Corte
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Fernandopulle
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Catuneanu
authors.affiliation: Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Burger
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Cesarini
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
authors.forename: Lydia
authors.initials: L
authors.lastname: White
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
authors.forename: Satish
authors.initials: S
authors.lastname: Keshav
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK simon.travis@ndm.ox.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Travis
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000473:pathology* / Q000628:therapy*; D003113:Colonoscopy; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab; D006854:Hydrocortisone
keywords: UCEIS; acute severe colitis; endoscopy; outcomes; ulcerative colitis