Systematic review: Scores used to predict outcomes in acute severe ulcerative colitis
Maia Kayal, Hadar Meringer, Lily Martin, Jean‐Frédéric Colombel
Abstract
Summary Background Approximately 25% of patients with ulcerative colitis (UC) experience an episode of acute severe ulcerative colitis (ASUC) during their disease course. Management and risk stratification of these patients is a great unmet medical need. Aim To review the literature systematically all currently available scores used to predict outcomes in patients with ASUC. Methods We executed a comprehensive search comprising both index terms and keywords in MEDLINE, Embase and Cochrane CENTRAL databases. We included observational cohort studies that reported on scoring indices to predict outcomes in patients admitted with ASUC defined by the Truelove and Witts criteria. We excluded studies that reported on risk factors of outcomes in patients with ASUC in isolation, not in the context of a score. Results The literature search identified 8729 studies, of which 18 were chosen to report 19 scores. Most scores included clinical and/or laboratory components. Two included imaging assessed by abdominal plain films; five included endoscopy assessed by the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) or the Mayo Score. Outcomes included intravenous corticosteroid response and short‐ and long‐term colectomy. The reported positive predictive value of the scores ranged from 70 to 100% for their respective outcome. Discussion Multiple scores exist for the prediction of outcomes in patients with ASUC, although each has limitations. A new score that reflects the current standard of care is needed to inform risk stratification in patients with ASUC.