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. 2018 Feb;6(1):38-44.
doi: 10.1093/gastro/gox016. Epub 2017 Apr 26.

Ulcerative Colitis Endoscopic Index of Severity (UCEIS) versus Mayo Endoscopic Score (MES) in guiding the need for colectomy in patients with acute severe colitis

Tingbin Xie  1 , Tenghui Zhang  2 , Chao Ding  2 , Xujie Dai  2 , Yi Li  2 , Zhen Guo  2 , Yao Wei  2 , Jianfeng Gong  1   2 , Weiming Zhu  2 , Jieshou Li  2
Affiliations

Ulcerative Colitis Endoscopic Index of Severity (UCEIS) versus Mayo Endoscopic Score (MES) in guiding the need for colectomy in patients with acute severe colitis

Tingbin Xie et al. Gastroenterol Rep (Oxf). 2018 Feb.

Abstract

Background: The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Mayo Endoscopic Score (MES) were developed as an objective method of the endoscopic severity in ulcerative colitis (UC); however, it was still unclear whether UCEIS vs MES could guide the need for colectomy in acute severe colitis (ASC).

Methods: Consecutive ASC patients between January 2012 and May 2016 were retrospectively evaluated. Demographic data, previous therapy, clinical observations, laboratory parameters, medical therapy and endoscopic assessments were documented. The primary outcome was the need for colectomy during admission and follow-up.

Results: Ninety-two patients were enrolled. 37 (40.2%) needed colectomy. UCEIS score is a predictor of requirement for colectomy in multivariate analysis (OR, 3.25; 95% CI, 1.77-5.97; P < 0.001). Receiver-operator characteristic (ROC) area of UCEIS is 0.85, with a sensitivity of 60.3% and specificity of 85.5% using cut-off value of 7, which outperforms MES with the ROC area of 0.65; When UCEIS score ≥7, 80% of patients eventually need colectomy.

Conclusion: UCEIS outperformed MES as a predictor for need for colectomy in ASC patients. The high probability of medical treatment failure and benefits of early colectomy should be discussed in patients with baseline UCEIS ≥ 7.Acute severe colitis; colectomy; Ulcerative Colitis Endoscopic Index of Severity; Mayo Endoscopic Score.

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Figures

Figure 1
Figure 1
Relationship between the different UCEIS score and colectomy during admission or follow-up expressed as odds ratio of colectomy. Bars represent 95% confidence interval.
Figure 2
Figure 2
ROC curves of UCEIS vs MES in predicting colectomy. UCEIS (area under the curve [AUC] = 0.85, cut-off value: 7) had a sensitivity of 60.3% and specificity of 85.5%, and MES (AUC=0.65, cut-off value: 2.5) had a sensitivity of 89.2% and specificity of 43.6%.
Figure 3
Figure 3
Colectomy-free survival rates in patients with UCEIS ≥ 7 vs UCEIS < 7, and in patients with MES = 3 vs MES = 2.
Figure 4
Figure 4
Overall hospitalization expenses of no colectomy (NC) vs early colectomy (EC) vs late colectomy (LC) in patients with UCEIS ≥ 7.
See this image and copyright information in PMC

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