Predicting Outcome in Acute Severe Colitis—Controversies in Clinical Practice in 2021

Abstract

Acute severe ulcerative colitis (ASUC) remains a common medical emergency, with 25% of patients with ulcerative colitis experiencing at least one event in their disease course. Despite advances in medical therapy, ASUC continues to be associated with considerable morbidity and mortality, with up to 30% of patients requiring colectomy during initial admission. Our aim was to review the current controversies and recent progress in risk stratification, prediction of outcome, and personalisation of care in ASUC. We re-assess the use of Truelove and Witts’ criteria, serum biomarkers and the use of composite clinical indices in current clinical practice. We explore the potential for endoscopic prediction using defined validated indices for accurate and early prognostication, and the need to define outcome. We also consider the impact of the current COVID-19 pandemic. Finally, we discuss the current research agenda including the application of new and emerging biomarkers coupled with multi-omics and the implications in management and optimisation of outcome.

Vitexin Protects against Dextran Sodium Sulfate-Induced Colitis in Mice and Its Potential Mechanisms

“…These results indicated that vitexin may be a promising agent for colitis treatment. However, as compared to chronic colitis model, acute colitis model can not reflect the dynamic course of colitis development in patients . So, further investigation should be performed to explore the effect of vitexin on treating DSS-induced chronic ulcerative colitis in the future.…”

Development and validation of novel models for the prediction of intravenous corticosteroid resistance in acute severe ulcerative colitis using logistic regression and machine learning

“…Biomarkers and composite scoring systems might help predict outcomes in ASUC. However, the roles of individual biomarkers require further clarification and there remains considerable uncertainty over the utility and preferences of the scoring system [ 27 ]. An effective predictive tool could help physicians identify patients requiring escalation to reduce unnecessary steroid exposure and improve prognosis.…”

“…In the future, the model can be modified by adjusting the baseline hazard or model intercept to better suit the average outcome risk in a larger external population [ 35 ]. Second, endoscopic features and laboratory data are currently routinely involved in the diagnosis and decision-making of clinicians, which could introduce circularity of argument, an inevitable inherent issue in data interpretation, and a prospective study may help in the future [ 27 ]. Moreover, in addition to endoscopic features and laboratory data, many novel predictors for IVCS response in UC patients have been proposed, including fecal calprotectin levels [ 36 , 37 ] and histological indices [ 38–40 ].…”

Improving prediction of disease outcome for inflammatory bowel disease: progress through systems medicine

“…Importantly, by treating patients with a predicted severe disease more aggressively early on, the natural course of the disease might be changed thereby improving long-term outcome. This applies for both – newly diagnosed patients and for patients during the disease course in case of severe complications requiring hospitalization for urgent rescue therapy [ 17 ]. However, current data comparing generalized top-down (i.e.…”