Bowel ultrasound enhances predictive value based on clinical indicators: a scoring system for moderate-to-severe endoscopic activities in patients with ulcerative colitis

Abstract

Background and Aim: The aim was to assess non-invasive factors among clinical features, laboratory, and bowel ultrasound (BUS) characteristics and to develop a scoring system to predict endoscopic activities for ulcerative colitis (UC) patients. Methods: We performed a retrospective study collecting UC patients between January 2015 to September 2020. Logistic regression was performed to predict moderate-to-severe endoscopic activities, defined as endoscopic Mayo score ⩾2. Model performance was described with discrimination and calibration ability and validated by internal and external methods. Results: A total of 103 and 29 patients were enrolled in the modeling and validation groups, respectively. Stool frequency ⩾5 times/day, hematochezia, erythrocyte sedimentation rate (ESR), and colonic wall flow in BUS were included into two predictive models for endoscopic activities, both with good discrimination ability [Area under curve (AUC) 0.879 and 0.882, p < 0.001] and a sensitivity of 76.7% and specificity of 92.3%, which showed an adequate calibration ability by using the Hosmer–Lemeshow test ( p = 0.14 and 0.07). The external validation displayed consistent results with the above mentioned. Nomograms were also established for these models. Conclusion: We developed predictive models for endoscopic disease activities by using noninvasive factors based on stool frequency, hematochezia, ESR, and colonic wall blood flow in BUS. These models performed well in the internal and external validation.

Intestinal ultrasound scan predicts corticosteroid failure and colectomy risk in patients with ulcerative colitis

“…Despite its efficacy, IUS is underutilized in assessing ulcerative colitis severity assessment and predicting severe cases. Zhang et al [32] developed a scoring system to predict moderateto-severe endoscopic ulcerative colitis activity using colonic blood flow and clinical/laboratory indicators. However, this scoring system lacks the critical IUS feature of colonic wall thickness, widely used to assess disease activity and treatment responses.…”

Risk prediction model based on blood biomarkers for predicting moderate to severe endoscopic activity in patients with ulcerative colitis

“…In 2021, Zhang ( 3 ) developed a model to predict moderate to severe activity under Mayo endoscopic subscore in UC patients based on fecal frequency, hematochezia, erythrocyte sedimentation rate and intestinal wall blood flow index through transabdominal bowel ultrasound. The model relied on ultrasonographic equipment and experienced radiologists.…”

“…Many non-invasive or minimally-invasive parameters were associated with inflammatory bowel disease activity or severity in recent years, including clinical features such as stool frequency and hematochezia (3); blood indicators such as C-reactive protein, erythrocyte sedimentation rate, serum amyloid A, ferritin transferrin, haptoglobin, vitamin D (Vit D), albumin (ALB), fibrinogen (Fbg), white blood cell count, platelet count, and cytokines; fecal indicators such as fecal occult blood, fecal immunochemical test, calprotectin, and lactoferrin (4)(5)(6)(7). Fecal calprotectin is a non-invasive biomarker that assesses intestinal inflammation and is a more sensitive marker than CRP for detecting inflammatory bowel disease activity (8).…”