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P470 DUBLIN (Degree of Ulcerative colitis Burden of Luminal INflammation) score, a simple method to quantify inflammatory burden in ulcerative colitis

C. R. Rowan*1, G. Cullen1, H. E. Mulcahy1, J. Sheridan1, A. C. Moss2,3, E. J. Ryan1, G. A. Doherty1

1St.Vincent's University Hospital, Center for Colorectal Disease, Dublin, Ireland, 2Beth Israel Deaconess Medical Center, Gastroenterology, Boston, USA, 3Harvard Medical School, Boston, USA

Background

Endoscopic scores of local severity do not reflect disease extent or disease burden. The DUBLIN score is a simple bedside clinical score that estimates inflammatory burden using both disease severity and extent. As the need to personalise therapy for UC patients increases, a score to accurately assess disease burden will be of great relevance. The aim of this study was to assess the clinical utility of the DUBLIN score by comparing its performance with objective biomarkers.

Methods

DUBLIN score was calculated as a product of Mayo Endoscopic Score (0–3) and disease extent (E1-E3). Correlation with objective biomarkers was performed in a retrospective ‘discovery cohort’. A validation cohort was recruited from a single-centre, where clinical outcomes, colectomy rate, and biochemical data were collected prospectively.

Results

The discovery cohort included 70 patients with UC.

Age (median; IQR)36.5 years (26–47.25)DUBLIN Score (n = 70)
Gender (male; n; %)37 (52.8)16 (23%)
C-reactive protein (median; IQR)2 (IQR 1–7.25)116 (23%)
Albumin (median; IQR)37 (IQR 35–39)217 (24%)
Faecal calprotectin (median; IQR)94.5 (15.75–1142.25)35 (7%)
Extent<strong>Mayo <strong>Endoscopic Score43 (4%)
E0 (no active disease)16 (23%)Mayo 016 (23%)69 (13%)
E129 (41%)Mayo 125 (36%)94 (6%)
E211(16%)Mayo 221 (30%)
E314 (20%)Mayo 38 (11%)

Patient characteristics, disease extent, Mayo endoscopic score, and DUBLIN score calculated in the discovery cohort. (n = 70).

DUBLIN score correlated significantly with faecal calprotectin levels. (r = 0.394; p < 0.01). ROC analysis using FCP >50 μg/g showed a higher AUC with DUBLIN score (AUC = 0.76) than Mayo Score (AUC 0.73).

Receiver-operating characteristic (ROC) curves constructed using a faecal calprotectin measurement of >50 μg/g as the threshold to define disease activity. DUBLIN score (AUC = 0.76) (Panel A) was greater than either Mayo score or extent alone.

The validation cohort included 41 patients. Patients with high inflammatory burden (DUBLIN >3) had higher C-reactive protein and faecal calprotectin, and lower albumin than low inflammatory burden patients.

DUBLIN score<3 (n = 18)≥3 (n = 23)p-value
Age (median; IQR)47 (36–69)39 (27–46)0.07
Gender (male; n(%))11 (61.1)15 (65.2)0.79
Disease duration (years) (median; IQR)10 (1–13)10 (3–16)0.39
Faecal calprotectin (μg/g) (median; IQR)185 (19–1060)1222 (381–3000)0.03*
Albumin (g/l) (median; IQR)40 (37.5–41)34 (28.75–39.25)0.003*
C-reactive protein (mg/l) (median; IQR)3 (1–6)13 (2.75–36.75)0.002*

Patient demographics and biochemical data based on ‘high’ (Dublin score ≥3) and ‘low’ inflammatory burden (Dublin <3) in the ‘validation’ cohort.

High DUBLIN score was associated with an increased risk of treatment failure (introduction/escalation of biologic agents, introduction of immunomodulators, use of oral steroids or surgery). (HR 2.98; 95% CI 1.002–8.87; p = 0.049).

High inflammatory burden is associated with a significantly higher risk of treatment failure in the validation cohort.

Conclusion

The DUBLIN score is a simple measure of inflammatory burden which correlates with objective inflammatory markers and is associated with clinical outcomes such treatment failure. DUBLIN score has the potential to assist in personalising therapy for patients with UC.