Colon to Rectum

Aliment Pharmacol Ther. 2024;60(7):921-933

Croft A, Okano S, Hartel G, Lord A, Walker G, Tambakis G, Radford-Smith G

A personalised algorithm predicting the risk of intravenous corticosteroid failure in acute ulcerative colitis

Background: An episode of acute ulcerative colitis (UC) represents an important watershed moment in a patient’s disease course.
Aims: To derive a personalised algorithm for identifying patients at high risk of corticosteroid non-response from variables available at hospital presentation using a large prospectively collected acute UC patient database and machine learning-based techniques.
Methods: The authors analysed data from 682 consecutive presentations of acute UC. They used an Akaike information criterion-based elastic net model to select variables based on the 419 earliest presentations of acute UC (1996–2017). They constructed 2 risk-scoring algorithms, with and without utilising additional endoscopic variables, using logistic regression models. They validated these risk scores on separate cohorts of 181 (2018–2022) and 82 (2015–2022) acute UC presentations.
Results: The partial risk of rescue (ROR) score included the admission indices of oral corticosteroid treatment, bowel frequency ≥ 6/24 h, albumin, CRP ≥ 12 mg/mL and log10CRP. The full ROR score incorporates the same variables with the addition of the Mayo endoscopic subscore and disease extent. The AUCs in the main validation cohort were 0.76 (95% confidence interval [CI]: 0.69–0.83) and 0.78 (95% CI: 0.71–0.85) for the partial and full ROR scores, respectively.

Conclusions: These pragmatic personalised risk scores (available at www.severecolitis.com) have comparably strong performance characteristics and usability enabling the identification of individuals at high risk of corticosteroid non-response before or after endoscopic assessment. The risk of rescue scores have the potential to challenge conventional acute ulcerative colitis treatment paradigms by identifying patients who may benefit from early rescue therapy or participation in relevant clinical trials.

DOI:  10.1111/apt.18190