Biomarkers in the early prediction of rescue therapy in acute severe colitis- a single-centre retrospective study

[...]26% of cases fail steroid treatment and require rescue therapy according to a recent Auckland study.2 The Day 3 Oxford Criteria is an older composite prediction tool that defines steroid failure to direct rescue therapy but its predictive value is controversial in the biologies era.34 Therefore, recent studies have been focused on biomarkers such as C-reactive protein/albumin ratio (CAR) or faecal calprotectin (fCal) to provide earlier rescue therapy prediction.5-1 The multi-centre cohort study on ASC from 2016 to 2019 across all three district health boards (DHBs) in Auckland showed significantly less need for rescue therapy in first-line intravenous hydrocortisone treatment compared to intravenous methylprednisolone.2 We present a subsequent retrospective study based on the data from one of the DHBs to examine the predictive value of CAR and fCal for rescue therapy in ASC. Methods Cases of ASC admissions to North Shore hospital as defined by Truelove and Witts criteria in the Waitemata DHB protocol were identified in the study by Schauer et al. between June 2017 and June 2018.28 This cohort was retrospectively examined for their age, gender, ethnicity, smoking status, type of IBD, admission C-reactive protein (CRP), admission albumin, admission fCal or recent fCal within 4 weeks prior to admission. If a biomarker was found to be significantly different between rescue and non-rescue groups, Area under the Receiver operating characteristic analysis was used to evaluate the optimal cut-off and multivariate analysis through multiple logistic regression was performed to verify statistical significance when potential confounding variables are included.