Contemporary multicentre validation and comparative performance of Day 1 prognostic scores in acute severe ulcerative colitis.

BACKGROUND AND AIMS: Early identification of steroid non-response in acute severe ulcerative colitis (ASUC) is critical to guide timely escalation of therapy. Several Day 1 prognostic scores have been proposed, but their comparative performance in contemporary cohorts remains uncertain, with limited direct head-to-head validation in real-world populations. We aimed to validate and directly compare the performance of previously proposed Day 1 prognostic scores, including the Admission Model for Intensification of Therapy in Acute Severe Colitis (ADMIT-ASC), the Albumin-C reactive protein-Endoscopy (ACE) index, and the Risk of Rescue (ROR) score, in a contemporary multicenter ASUC cohort.

METHODS

We conducted a multicenter retrospective study of adults hospitalized with ASUC across three tertiary Australian centers between 2018 and 2023. The performance of ADMIT-ASC, ACE, and ROR scores for predicting steroid non-response, as defined by the Oxford criteria, was assessed using receiver operating characteristic analysis.

RESULTS

Among 238 patients, 134 (56.3%) met criteria for steroid non-response and required medical rescue therapy. All three scores demonstrated moderate discrimination, with AUROC highest for ROR (0.72), followed by ADMIT-ASC (0.68) and ACE (0.66) (P = .17). At published thresholds, ADMIT-ASC and ACE demonstrated high specificity but low sensitivity, whereas ROR provided greater sensitivity with lower specificity. In subgroup analyses, the discriminative performance of the Day 1 scores was broadly similar in biologic-naive and biologic-exposed patients.

CONCLUSION

Day 1 prognostic scores demonstrate moderate performance in contemporary ASUC, with differing trade-offs between sensitivity and specificity. These findings support the use of Day 1 risk scores as adjuncts to early clinical decision-making in ASUC.