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
Article first published online: 29 APR 2004
Alimentary Pharmacology & Therapeutics
Volume 19, Issue 10, pages 1079–1087, May 2004
How to Cite
Ho, G. T., Mowat, C., Goddard, C. J. R., Fennell, J. M., Shah, N. B., Prescott, R. J. and Satsangi, J. (2004), 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. Alimentary Pharmacology & Therapeutics, 19: 1079–1087. doi: 10.1111/j.1365-2036.2004.01945.x
- Issue published online: 29 APR 2004
- Article first published online: 29 APR 2004
- Accepted for publication 17 March 2004
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 ≥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 ≥4 in predicting non-response.
Conclusion : This risk score allows the early identification of patients with severe ulcerative colitis who would be suitable for second-line medical therapy or surgery.