Contemporary multicentre validation and comparative performance of Day 1 prognostic scores in acute severe ulcerative colitis
In brief
Day 1 scores identify steroid non-response in 56% of severe colitis admissions
In a three-center study of 238 adults hospitalized with acute severe ulcerative colitis, 56% did not respond to steroids and needed rescue therapy. Three Day 1 scores showed only moderate ability to predict non-response, with different trade-offs between sensitivity and specificity; they can support, but not replace, clinical judgment.
- Journal
- Journal of Crohn's & colitis (Q1)
- Published
- 9 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Deloshaan Subhaharan, Waled Mohsen, Asif Shahzad, Desmond Patrick, Lauren White, Pradeep Kakkadasam Ramaswamy
- PMID
- 42854106
- DOI
- 10.1093/ecco-jcc/jjag155
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 12 October 2026): Validation of Day‑1 prognostic scores in acute severe UC
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.