Scores Predict Corticosteroid Failure Risk in Patients With ASUC

Two personalized risk scores showed strong performance for predicting the risk of intravenous corticosteroid failure before or after endoscopic assessment in patients with acute ulcerative colitis (UC), according to a study published in Alimentary Pharmacology and Therapeutics.

“The ROR [risk of rescue] scores have the potential to challenge conventional acute UC treatment paradigms by identifying patients who may benefit from early rescue therapy or participation in relevant clinical trials,” wrote corresponding author Anthony Croft, MBBS, of Royal Brisbane and Women’s Hospital, Brisbane, Australia, and study coauthors.

Researchers used data from 419 consecutive patients with acute UC at a single hospital to identify clinical and laboratory variables available at presentation that were associated with subsequent corticosteroid nonresponse. The resulting 2 risk-scoring algorithms, one with and one without additional endoscopic variables, were validated in separate cohorts of 181 patients and 82 patients presenting with acute UC.   

Variables in the partial ROR model, which excluded endoscopic variables, were oral corticosteroid treatment, bowel frequency of 6 or more times per day, albumin, C-reactive protein (CRP) ≥12 mg/mL, and log₁₀CRP. The full ROR model included the same variables plus the Mayo endoscopic subscore and disease extent.

Area under the curves (AUCs) were 0.76 for the partial ROR score and 0.78 for the full ROR scores in the main validation cohort of 181 patients. In the validation cohort of 82 patients receiving biologic or other advanced therapies at the time of hospital presentation, AUCs were 0.76 for the partial ROR score and 0.77 for the full ROR score.

“With regards to changing current clinical practice, the ROR score can inform the clinician as to the risk of corticosteroid therapy non-response in a clinically meaningful way,” researchers wrote. “The earlier institution of treatment escalation in the form of intensified medical therapy or surgery has been observed to confer improved medium- and long-term outcomes in severe UC patients.”

The ROR risk calculator is available at www.severecolitis.com

Reference

Croft A, Okano S, Hartel G, et al. A personalised algorithm predicting the risk of intravenous corticosteroid failure in acute ulcerative colitis. Aliment Pharmacol Ther. Published online August 7, 2024. doi:10.1111/apt.18190