Zhang Xiao-Fei, Li Peng, Ding Xue-Li, Chen Hao, Wang Shao-Jun, Jin Sheng-Bo, Guo Jing, Tian Zi-Bin
Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, P.R. China.
Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, P.R. China.
Gastroenterol Rep (Oxf). 2021 Jul 15;9(6):533-542. doi: 10.1093/gastro/goab026. eCollection 2021 Dec.
The significance of endoscopic evaluation in the diagnosis and management of ulcerative colitis (UC) has been widely recognized. Over the years, scholars have established several endoscopic scores. Herein, we assessed the clinical application value of the Mayo Endoscopic Subscore (Mayo ES), the Degree of Ulcerative Colitis Burden of Luminal Inflammation (DUBLIN) score, and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score in UC patients, by comparing their correlation with disease activity and their predictive potential for treatment response and clinical outcomes.
UC patients hospitalized from September 2015 to September 2019 were retrospectively analysed. We employed Spearman's rank correlation coefficient to assess the linear association of the assessed endoscopic scores with the clinical parameters. The receiver-operating characteristic curve was applied to evaluate the predictive capabilities of the endoscopic scores for treatment escalation and 1-year readmission.
A total of 178 patients were enrolled; most of them (82%) suffered moderate or severe colitis. Among them, 48 (27%) patients received treatment escalation and 59 (33%) were readmitted within 1year. The DUBLIN and UCEIS scores demonstrated higher correlations with clinical parameters than the Mayo ES. The DUBLIN scores significantly differed between patients with mild, moderate, and severe colitis (all <0.001). The UCEIS scores demonstrated the best predictabilities for treatment escalation and 1-year readmission with an area under the curve of 0.88 and 0.75, respectively. Compared to the UCEIS and DUBLIN scores, the predictive capabilities of the Mayo ES for treatment escalation (both <0.001) and 1-year readmission (<0.001 and =0.002, respectively) were lower. The UCEIS scores exhibited a significant difference between the steroid-responsive group and the steroid-dependent or steroid-refractory group (both <0.001), while no significant differences in the Mayo ES and DUBLIN scores were found among the three groups (both >0.05).
This study demonstrates that both the DUBLIN and UCEIS scores outperform the Mayo ES in assessing disease severity and predicting treatment response and clinical outcomes in UC patients.
内镜评估在溃疡性结肠炎（UC）诊断和管理中的意义已得到广泛认可。多年来，学者们建立了多种内镜评分系统。在此，我们通过比较梅奥内镜子评分（Mayo ES）、溃疡性结肠炎肠腔炎症负担程度（DUBLIN）评分和溃疡性结肠炎内镜严重程度指数（UCEIS）评分与疾病活动度的相关性及其对治疗反应和临床结局的预测潜力，评估了它们在UC患者中的临床应用价值。
对2015年9月至2019年9月住院的UC患者进行回顾性分析。我们采用Spearman等级相关系数评估所评估的内镜评分与临床参数的线性关联。应用受试者工作特征曲线评估内镜评分对治疗升级和1年再入院的预测能力。
共纳入178例患者；其中大多数（82%）患有中度或重度结肠炎。其中，48例（27%）患者接受了治疗升级，59例（33%）在1年内再次入院。DUBLIN和UCEIS评分与临床参数的相关性高于Mayo ES。轻度、中度和重度结肠炎患者的DUBLIN评分有显著差异（均<0.001）。UCEIS评分对治疗升级和1年再入院的预测能力最佳，曲线下面积分别为0.88和0.75。与UCEIS和DUBLIN评分相比，Mayo ES对治疗升级（均<0.001）和1年再入院（分别为<0.001和=0.002）的预测能力较低。UCEIS评分在激素反应组与激素依赖或激素抵抗组之间存在显著差异（均<0.001），而Mayo ES和DUBLIN评分在三组之间未发现显著差异（均>0.05）。
本研究表明，DUBLIN和UCEIS评分在评估UC患者疾病严重程度以及预测治疗反应和临床结局方面优于Mayo ES。
