Association between the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and outcomes in acute severe ulcerative colitis

Background The UCEIS accounts for 86% of variance between observers in the overall assessment of endoscopic severity, but has not been correlated with outcomes. Methods Consecutive cases of acute severe colitis (ASC) defined by Truelove and Witts' (TW) criteria were retrospectively evaluated. Demographic details, number of TW criteria, prior medical therapy, UCEIS and inpatient medical therapy were recorded. Pre-specified (adverse) endpoints included rescue therapy, colectomy and readmission. Results 89 patients, 48 (54%) male, mean age 38 years, all received intravenous hydrocortisone 400mg/d (median 5 days [range 1-11]). Median follow up was 14 months (2-33). 48 (54%) were diagnosed the year prior to, or at admission. 36 (40%) required rescue therapy (infliximab (IFX) 25/36, ciclosporin (CsA) 12/36, one receiving both). 21/89 (24%) underwent colectomy on the index admission (9/21) or during follow-up (12/21). Median UCEIS score was 5/8 (3-8). UCEIS was higher in patients requiring rescue therapy or colectomy (median score 6/8 (range 4-8) vs 5/8 (3-8), both p<0.005). For a UCEIS >5/8, 27/54 (50%) required rescue therapy, compared to 9/33 (27%) for UCEIS <4 (p=0.037). When UCEIS was >5/8, 18/54 (33%) came to colectomy during follow-up, compared to 3/33 (9%) with UCEIS <4. Of 14 patients with a UCEIS 7 or 8/8, 11/14 needed rescue therapy and 13/14 met any adverse endpoint. Conclusion Endoscopic severity is associated with a worse outcome in ASC. When the UCEIS is ≥7/8 on admission, almost all patients will need treatment with IFX or CsA beyond steroids. This may mark a threshold for an early decision to use IFX or CsA