Introduction
Patients with acute severe ulcerative colitis (ASUC) have a lifetime risk of an acute flare requiring hospital stay. The diagnosis of acute severe ulcerative colitis is based on Truelove and Witts criteria and the treatment by intravenous steroids showed improved clinical remission and reduced mortality. However, some patients respond poorly to systemic steroids and need a medical treatment by of anti TNF agents or a surgical treatment by colectomy. The aim of our work is to study the ACE score as a predictive factor of surgery in acute severe ulcerative colitis.
Aims & Methods
We conducted a retrospective study on the Hepato gastro enterology department in IBN Rochd University Hospital of CASABLANCA, including all the admissions of patients with acute severe ulcerative colitis between 2016 and 2023. Demographic (sex, age, smoking habits ,age of the diagnosis, prior episodes of severe ulcerative colitis, extent of the disease according to Montreal classification, maintenance medication prior to hospital admission) , clinical (lichtiger score at admission and 3 days after IV steroid, laboratory (albumin, CRP) at day 1 and day 3 during hospital stay and endoscopic (Mayo score and UCEIS) characteristics of the patients were collected from medical records. The primary outcome was to calculate the ACE score and determine the association between a high score and a major risk of surgery. The score ACE was calculated following this formula: albumin≤30 g/L{score=1}+ CRP ≥50 mg/L{score=1} + increased endoscopic severity {score=1} predicting 78.1% of no responders .
Results
97 patients were included in the study. The median age was 28 years with interquartile range (IQ) [15, 64]. The sex ratio was 1. 22,7% had a history of smoking. For 53 patients, acute severe ulcerative colitis was inaugural. At day1, the median C-reactive protein (CRP) was 84 mg/dl and the mean of albumin level was 29.9+/-6.28. The evolution at day 5 was marked by the persistence of a high Lichtiger score in 21 patients. 10 were treated with anti TNF alpha and 11 underwent colectomy. Younger age (<20 years) and inaugural acute severe ulcerative colitis was significantly associated with a higher risk of colectomy (p=0.019; p=0.001). Elevated C-reactive protein (>45) at day 3 (p=0.004), decreased albumin level (<30g/L) (p=0.02) and positive oxford criteria (p<0.01) was also significantly associated with colectomy risk. The ACE (Albumin, CRP, Endoscopic) score was calculated in our patients, and a higher score of 3 was significantly associated to a major risk of colectomy.
Conclusion
Multiple biomarkers have been used to predict a non-response to steroids in the situation of acute severe ulcerative colitis. The most used is Travis score at day 3. The ACE score has been used recently in many studies , and confirm its ability to predict non responders to first line medical therapy. Further research and validation of these scoring systems are warranted to enhance their accuracy and reliability in predicting the need for a second line therapy or surgery.
References
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