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Lindgren score predicts disease course in acute severe ulcerative colitis
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The Lindgren score was better than three other currently available scores at predicting major clinical outcomes in patients with acute severe ulcerative colitis, according to research published in Inflammatory Bowel Diseases.
Sónia Bernardo, MD, of the Hospital de Santa Maria in Lisbon, Portugal, and colleagues wrote this could help determine which patients will benefit from intravenous corticosteroids (IVS) when hospitalized. As many as 30% to 40% of patients either do not respond or only partially respond to IVS. When that happens, rescue therapy with Remicade (infliximab, Janssen), cyclosporine or colectomy is required.
“Several early predictors of IVS failure have been suggested, including clinical parameters such as the number of bowel movements, laboratory markers such as serum albumin and C-reactive protein, fecal biomarkers such as fecal calprotectin, and radiologic and endoscopic findings such as colonic dilation and deep ulceration,” the researchers wrote. “The available predictive scores combine two or more of these parameters. To date, there has been no formal comparison between the different scores.”
Bernardo and colleagues compared the Lindgren score, the Mayo endoscopic subscore, the Oxford score and the Edinburgh score in a single-center retrospective study of 489 patients with UC. They evaluated the scores for their ability to predict the need for rescue therapy, surgery and IVS failure defined as the need for salvage therapy and/or surgery.
Of the total patient population, 112 patients presented with acute severe UC, and 42% of those patients showed incomplete or no response to IVS (28.6% received rescue therapy and 26.8% required surgery).
Investigators found that among the four scores, the Lindgren score had the highest performance in predicting IVS failure (area under the curve = 0.856; 95% CI, 0.784–0.928), need for medical rescue therapy (AUC = 0 .826; 95% CI, 0.749–0.902) and surgery (AUC = 0.836; 95% CI, 0.712–0.96; all P < .01).
Bernardo and colleagues wrote that their findings could help guide management of patients hospitalized for acute severe UC.
“Early identification of patients who will not respond to intravenous steroids and other rescue therapies is crucial,” they wrote. “We have shown in a retrospective analysis that the Lindgren score is the most accurate in predicting important outcomes in patients with [acute severe UC].” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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