P168 Predicting outcome in acute severe ulcerative colitis: Comparison of the Oxford, Edinburgh, Lindgren and endoscopic Mayo scores

Abstract Background Up to one-third of patients with acute severe ulcerative colitis (ASUC) will fail intravenous corticosteroids (IVCT) treatment, requiring rescue therapy with Cyclosporin (Cy), Infliximab (IFX) or colectomy. Although several scores for predicting response to IVCT exist, formal comparison is lacking. Methods This was a retrospective cohort single-center study. The endoscopic Mayo score and the Oxford, Edinburgh and Lindgren scores were determined at admission and on the third day of IVCT treatment, respectively. Outcomes included prediction of steroid refractoriness, need for rescue medical therapy and surgery. Results From 489 patients with ulcerative colitis, 112 presented with ASUC; 58% were male with a median age of 33.5 years (range 18–80). The median of Truelove and Witts score was 4 (range 2–5). Thirty-five percent of patients showed an incomplete or absent response to IVCT, 28.6% received rescue medical therapy (65.6% with IFX, 31.3% with Cy and 3.1% received sequential therapy with Cy and IFX) and 13.4% were colectomized up to 1 year from admission. The Lindgren score was superior to the Edinburgh score (AUC 0.856 [0.784–0.928] vs. 0.775 [0.682–0.869], p = 0.01) and the Mayo score (AUC 0.699 [0.597–0.801], p = 0.02), but not to the Oxford score (AUC 0.746 [9.651–0.841], p = 0.14) in predicting steroid refractoriness. The Lindgren score was superior to the Mayo (AUC 0.826 [0.749–0.902] vs. 0.637 [0.525–0.749], p = 0.002) and Oxford scores (AUC 0.719 [0.617–0.821], p = 0.03), but similar to the Edinburgh score (AUC 0.771 0.678–0.865], p = 0.18) in predicting the need for medical rescue therapy. Finally, the Lindgren score was also a better predictor of the need of colectomy than the Edinburgh (AUC 0.836 [0.712–0.960] vs. 0.753 [0.608–0.897], p = 0.03) and Oxford scores (AUC 0.712 [0.587–0.837], p = 0.003), but not to Mayo score (AUC 0.782 [0.685–0.879], p = 0.47). In multivariate regression analysis, the Lindgren score was an independent predictor for steroid refractoriness (OR 1.647 1.111–2.441, p = 0.013) and need for medical rescue therapy (OR 1.410 1.033–1.926, p = 0.03). A Lindgren score >9 had a positive and negative predictive value for IVCT failure of 91.7% and 72.9%, respectively. Conclusions In our series, the Lindgren score was superior to the Edinburgh, Oxford and endoscopic Mayo scores in predicting steroid refractoriness, need for rescue medical therapy and colectomy.