title: The use of a segmental endoscopic score may improve the prediction of clinical outcomes in acute severe ulcerative colitis.
abstract: 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.
authors.affiliation: Gastrenterologia e Hepatologia, Hospital Santa Maria, Portugal.
authors.forename: Samuel Raimundo
authors.initials: SR
authors.lastname: Fernandes
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa , Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Santos
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa , Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Miguel Moura
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa , Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques da Costa
authors.affiliation: Gastrenterologia e Hepatologia, Centro Hospitalar Lisboa Norte, H. Santa Maria, Portugal.
authors.forename: Joana Rita
authors.initials: JR
authors.lastname: Carvalho
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Lisboa Norte, H. Santa Maria, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Isabel Valente
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa , Portugal.
authors.forename: Cilénia
authors.initials: C
authors.lastname: Baldaia
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Rita Gonçalves
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Moura Santos
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Araújo-Correia
authors.affiliation: Department of Gastroenterology and Hepatology, Hospital Santa Maria. North Lisbon Hospital Centre, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Velosa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000897:Anti-Ulcer Agents; D007166:Immunosuppressive Agents; D013256:Steroids