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P110. The use of the Pediatric Ulcerative Colitis Activity Index (PUCAI) in adults with acute severe ulcerative colitis (ASC)

B. Koslowsky1, A. Gupta2, D.M. Livovsky1, T. Adar1, D. Turner3, F. Hartnell4, C. Praticò5, S. Travis6, 1Shaare Zedek Medical Center, Gastroenterology, Jerusalem, Israel, 2The Canberra Hospital, Gastroenterology, Woden, Australian Capital Territory, Australia, 3Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Pediatric Gastroenterology, Jerusalem, Israel, 4Royal Brisbane and Women's Hospital, Gastroenterology, Brisbane, Queensland, Australia, 5University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italy, 6Oxford University Hospital, Translational Gastroenterology Unit, Oxford, United Kingdom

Background

The PUCAI is a commonly used non-invasive index for pediatric UC and a strong predictor of steroid-failure in ASC. None of its components are specific to children and it has been validated in ambulatory adult UC. We aimed to explore the predictive power of the PUCAI in an adult cohort of ASC.

Methods

This is a multicenter retrospective cohort study of 153 patients with ASC (53% male and 45% with extensive disease). The PUCAI, Oxford and Lindgren scores were calculated based on data collected from the first 5 days of admission. The primary outcome was need for salvage medical therapy or colectomy during hospitalization.

Results

The average PUCAI at days 1, 3 and 5 was 70±12, 44±19and 34±20, respectively. 35% of the cohort required salvage therapy [anti TNF (7%), cyclosporine (18%) or primary colectomy (10%)]. Total colectomy rate by discharge was 15% (n = 23). PUCAI at days 3 and 5 for patients who needed salvage therapy and those who did not were 55±13 and 48±18 vs. 37±18 and 25±16, respectively (P < 0.001 for each). The Area under the ROC curve of PUCAI at days 3 and 5 to predict salvage therapy was 0.76 (p < 0.001) and 0.82 (p < 0.001), respectively. A PUCAI cut off value <45 at day 3 had a NPV of 88% and PPV of 54% for salvage therapy, whereas a PUCAI >65 on day 5 had a PPV of 85% and NPV of 72%. The ROC curve of PUCAI changes from day 1 to day 5 had an AUC of 0.80 (p < 0.001). Oxford and Lindgren indices as well as CRP calculated on days 3 and 5 were not significant predictors, likely due to missing CRP data in many subjects.

Conclusion

As seen in children, the PUCAI is a valuable early predictor of steroid-failure in adults hospitalized with ASC. A PUCAI >45 on day 3 should prompt preparation for salvage therapy (i.e. sigmoidoscopy, tuberculosis screening, discussions with family etc) and a PUCAI >65 on day 5 should lead to starting the therapy. This multi-step algorithm identifies 70% of patients requiring salvage therapy within 5 days of admission with a high accuracy.