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Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset

Rebecca K Grant Orcid Logo, Gareth-Rhys Jones Orcid Logo, Nikolas Plevris Orcid Logo, Ruairi W Lynch Orcid Logo, William M Brindle Orcid Logo, Hayley Hutchings Orcid Logo, John G Williams, Laith Alrubaiy Orcid Logo, Alan Watkins Orcid Logo, Charlie W Lees Orcid Logo, Ian D R Arnott Orcid Logo, John Williams

Journal of Crohn's and Colitis, Volume: 18, Issue: 2, Pages: 286 - 290

Swansea University Authors: Hayley Hutchings Orcid Logo, Laith Alrubaiy Orcid Logo, Alan Watkins Orcid Logo, John Williams

  • Accepted Manuscript under embargo until: 24th August 2024

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DOI (Published version): 10.1093/ecco-jcc/jjad148

Abstract

Background and Aims: In 2020 we reported the ACE Index in acute colitis which used biochemical and endoscopic parameters to predict steroid non-response on admission in patients with acute ulcerative colitis [UC]. We aimed to validate the ACE Index in an independent cohort. Methods: The validation c...

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Published in: Journal of Crohn's and Colitis
ISSN: 1873-9946 1876-4479
Published: Oxford University Press (OUP) 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65093
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We aimed to validate the ACE Index in an independent cohort. Methods: The validation cohort comprised patients screened as eligible for inclusion in the CONSTRUCT study, a prospective, randomized, placebo-controlled trial which compared the effectiveness of treatment with infliximab vs ciclosporin in patients admitted with acute UC. The CONSTRUCT cohort database was reviewed at The Edinburgh IBD Unit and the same biochemical and endoscopic variables and cut-off values as those in the derivation cohort were applied to the validation cohort. Results: In total, 800 patients were identified; 62.5% [55/88] of patients with a maximum ACE Index of 3 did not respond to intravenous [IV] steroids (positive predictive value [PPV] 62.5%, negative predictive value [NPV] 79.8%). Furthermore, 79.8% [158/198] of patients with an ACE Index of 0 responded to IV steroids [PPV 79.8%, NPV 62.5%]. Receiver operator characteristic [ROC] curve analysis produced an area under the curve [AUC] of 0.663 [p &lt; 0.001]. Conclusions: We have now reported and externally validated the ACE Index in acute colitis in a combined cohort of over 1000 patients from across the UK. The ACE Index may be used in conjunction with clinical judgement to help identify patients admitted with active UC who are at high risk of not responding to IV steroids. 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spelling v2 65093 2023-11-24 Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset bdf5d5f154d339dd92bb25884b7c3652 0000-0003-4155-1741 Hayley Hutchings Hayley Hutchings true false 62b59abd526b328bbb125dfaa9bdcd6d 0000-0002-6340-8244 Laith Alrubaiy Laith Alrubaiy true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false 911a5c03419acf47eab0844e2cd5ab7f John Williams John Williams true false 2023-11-24 HDAT Background and Aims: In 2020 we reported the ACE Index in acute colitis which used biochemical and endoscopic parameters to predict steroid non-response on admission in patients with acute ulcerative colitis [UC]. We aimed to validate the ACE Index in an independent cohort. Methods: The validation cohort comprised patients screened as eligible for inclusion in the CONSTRUCT study, a prospective, randomized, placebo-controlled trial which compared the effectiveness of treatment with infliximab vs ciclosporin in patients admitted with acute UC. The CONSTRUCT cohort database was reviewed at The Edinburgh IBD Unit and the same biochemical and endoscopic variables and cut-off values as those in the derivation cohort were applied to the validation cohort. Results: In total, 800 patients were identified; 62.5% [55/88] of patients with a maximum ACE Index of 3 did not respond to intravenous [IV] steroids (positive predictive value [PPV] 62.5%, negative predictive value [NPV] 79.8%). Furthermore, 79.8% [158/198] of patients with an ACE Index of 0 responded to IV steroids [PPV 79.8%, NPV 62.5%]. Receiver operator characteristic [ROC] curve analysis produced an area under the curve [AUC] of 0.663 [p < 0.001]. Conclusions: We have now reported and externally validated the ACE Index in acute colitis in a combined cohort of over 1000 patients from across the UK. The ACE Index may be used in conjunction with clinical judgement to help identify patients admitted with active UC who are at high risk of not responding to IV steroids. Further studies are required to improve objectivity and accuracy of assessment. Journal Article Journal of Crohn's and Colitis 18 2 286 290 Oxford University Press (OUP) 1873-9946 1876-4479 Inflammatory bowel disease, ulcerative colitis, IV steroids 26 2 2024 2024-02-26 10.1093/ecco-jcc/jjad148 http://dx.doi.org/10.1093/ecco-jcc/jjad148 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University 2024-03-11T14:44:48.6248519 2023-11-24T13:28:59.5080052 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Rebecca K Grant 0000-0002-9440-1192 1 Gareth-Rhys Jones 0000-0001-7355-2357 2 Nikolas Plevris 0000-0002-3229-8759 3 Ruairi W Lynch 0000-0001-5116-9218 4 William M Brindle 0000-0002-8972-0332 5 Hayley Hutchings 0000-0003-4155-1741 6 John G Williams 7 Laith Alrubaiy 0000-0002-6340-8244 8 Alan Watkins 0000-0003-3804-1943 9 Charlie W Lees 0000-0002-0732-8215 10 Ian D R Arnott 0000-0003-3352-9253 11 John Williams 12 Under embargo Under embargo 2023-12-19T12:21:43.8557350 Output 810395 application/pdf Accepted Manuscript true 2024-08-24T00:00:00.0000000 true eng
title Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset
spellingShingle Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset
Hayley Hutchings
Laith Alrubaiy
Alan Watkins
John Williams
title_short Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset
title_full Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset
title_fullStr Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset
title_full_unstemmed Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset
title_sort Validation of the ACE [Albumin, CRP, and Endoscopy] Index in Acute Colitis: Analysis of the CONSTRUCT dataset
author_id_str_mv bdf5d5f154d339dd92bb25884b7c3652
62b59abd526b328bbb125dfaa9bdcd6d
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author_id_fullname_str_mv bdf5d5f154d339dd92bb25884b7c3652_***_Hayley Hutchings
62b59abd526b328bbb125dfaa9bdcd6d_***_Laith Alrubaiy
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
911a5c03419acf47eab0844e2cd5ab7f_***_John Williams
author Hayley Hutchings
Laith Alrubaiy
Alan Watkins
John Williams
author2 Rebecca K Grant
Gareth-Rhys Jones
Nikolas Plevris
Ruairi W Lynch
William M Brindle
Hayley Hutchings
John G Williams
Laith Alrubaiy
Alan Watkins
Charlie W Lees
Ian D R Arnott
John Williams
format Journal article
container_title Journal of Crohn's and Colitis
container_volume 18
container_issue 2
container_start_page 286
publishDate 2024
institution Swansea University
issn 1873-9946
1876-4479
doi_str_mv 10.1093/ecco-jcc/jjad148
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
url http://dx.doi.org/10.1093/ecco-jcc/jjad148
document_store_str 0
active_str 0
description Background and Aims: In 2020 we reported the ACE Index in acute colitis which used biochemical and endoscopic parameters to predict steroid non-response on admission in patients with acute ulcerative colitis [UC]. We aimed to validate the ACE Index in an independent cohort. Methods: The validation cohort comprised patients screened as eligible for inclusion in the CONSTRUCT study, a prospective, randomized, placebo-controlled trial which compared the effectiveness of treatment with infliximab vs ciclosporin in patients admitted with acute UC. The CONSTRUCT cohort database was reviewed at The Edinburgh IBD Unit and the same biochemical and endoscopic variables and cut-off values as those in the derivation cohort were applied to the validation cohort. Results: In total, 800 patients were identified; 62.5% [55/88] of patients with a maximum ACE Index of 3 did not respond to intravenous [IV] steroids (positive predictive value [PPV] 62.5%, negative predictive value [NPV] 79.8%). Furthermore, 79.8% [158/198] of patients with an ACE Index of 0 responded to IV steroids [PPV 79.8%, NPV 62.5%]. Receiver operator characteristic [ROC] curve analysis produced an area under the curve [AUC] of 0.663 [p < 0.001]. Conclusions: We have now reported and externally validated the ACE Index in acute colitis in a combined cohort of over 1000 patients from across the UK. The ACE Index may be used in conjunction with clinical judgement to help identify patients admitted with active UC who are at high risk of not responding to IV steroids. Further studies are required to improve objectivity and accuracy of assessment.
published_date 2024-02-26T14:44:45Z
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