Day 1 scores show moderate prediction of steroid non-response in severe ulcerative colitis

A multicenter retrospective study assessed three Day 1 prognostic scores in 238 adults hospitalized with acute severe ulcerative colitis at three Australian tertiary centers between 2018 and 2023. Investigators compared ADMIT-ASC, the Albumin-C reactive protein-Endoscopy (ACE) index, and the Risk of Rescue (ROR) score for predicting steroid non-response defined by the Oxford criteria.

Overall, 134 patients (56.3%) met criteria for steroid non-response and required medical rescue therapy. The area under the receiver operating characteristic curve was highest for ROR at 0.72, followed by ADMIT-ASC at 0.68 and ACE at 0.66; the difference was not statistically significant (P = .17). At published thresholds, ADMIT-ASC and ACE had high specificity but low sensitivity, whereas ROR offered greater sensitivity with lower specificity. Discrimination was broadly similar in biologic-naive and biologic-exposed subgroups.

These findings support using admission scores as adjuncts to early clinical assessment rather than standalone determinants of treatment escalation. The retrospective design and tertiary-center population limit generalizability. The available abstract does not provide confidence intervals or numerical sensitivity and specificity estimates, limiting assessment of precision and threshold-level clinical utility.