Feasibility and Validity of the Pediatric Ulcerative Colitis Activity Index in Routine Clinical Practice

Abstract

Objectives The Pediatric Ulcerative Colitis Activity Index (PUCAI) is a non-invasive disease activity index developed as a clinical trial endpoint. More recently, practice guidelines have recommended the use of PUCAI in routine clinical care. We therefore sought to evaluate the feasibility, validity and responsiveness of PUCAI in a large, diverse collection of pediatric gastroenterology practices. Methods We extracted data from the two most recent encounters for patients with ulcerative colitis in the ImproveCareNow registry. Feasibility was determined by the percent of patients for whom all PUCAI components were recorded, validity by correlation of PUCAI scores across Physician Global Assessment (PGA) categories, and responsiveness to change by the correlation between the change in PUCAI and PGA scores between visits. Results 2503 patients were included (49.5% male, age 15.2±4.1 years, disease duration 3.7±3.2 years). All items in the PUCAI were completed for 96% of visits. PUCAI demonstrated excellent discriminatory ability between remission, mild and moderate disease; discrimination between moderate and severe disease was less robust. There was good correlation with PGA [r=0.76 (p<0.001), weighted kappa k=0.73 (p<0.001)]. The PUCAI change scores correlated well with PGA change scores (p<0.001). Test-retest reliability of the PUCAI was good (intra-class correlation coefficient=0.72 [95% CI 0.70–0.75], p<0.001). Guyatt’s responsiveness statistic was 1.18 and the correlation of ΔPUCAI with ΔPGA was 0.69 (p<0.001). Conclusions The PUCAI is feasible to use in routine clinical settings. Evidence of its validity and responsiveness support its use as a clinical tool for monitoring disease activity for patients with ulcerative colitis.

Fecal and mucosal microbiota profiling in pediatric inflammatory bowel diseases

“…Pediatric patients (<18 years) with a diagnosis of IBD according to the recent Porto Criteria [7] were prospectively recruited at the Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome. Clinical activity was defined by a PCDAI >10 [8] and a PUCAI >10 [9] for CD and UC, respectively.…”

Longitudinal Patterns of Medication Nonadherence and Associated Health Care Costs

“…Standard care in the IBD Center includes routine assessment of disease severity via Physician Global Assessment (PGA) in which physicians rate patient disease activity as “quiescent,” “mild,” “moderate,” or “severe.” This approach correlates well with objective measures of disease severity in IBD including the PCDAI 30 and PUCAI 31 . Disease severity at each month was defined as the most recent previous PGA rating.…”

Expression profile of the matricellular protein periostin in paediatric inflammatory bowel disease

“…At the time of specimen collection, disease activity was recorded using validated assessment tools, Paediatric Crohn’s Disease Activity Index (PCDAI) and Paediatric Ulcerative Colitis Activity Index (PUCAI) for CD and UC respectively 25 , 33 , 34 , with a disease score < 10 indicating clinical remission in both conditions. The scoring indices for defining active disease were as follows: PUCAI (scores range from 0 to 85; remission or inactive disease < 10, mild disease 10–34, moderate 35–64, severe > 65) for UC and PCDAI (scores range from 0–100; remission or inactive disease < 10, mild 10–29, moderate-severe > 30) for CD.…”