Admission-Day ASUC Score Validated to Predict Steroid Non-Response

An MDPI report describes external, single-center validation of an admission-day acute severe ulcerative colitis (ASUC) score intended to help identify patients who may require escalation beyond IV corticosteroids.

The authors report a retrospective cohort spanning 2015–2024 with 91 ASUC admissions at a single center. Primary validation was performed in an infection-free subset (n=77), while admissions with superimposed infection were examined separately. The primary outcome was escalation beyond IV steroids during the index hospitalization, defined as medical rescue therapy (infliximab or ciclosporin) and/or colectomy; the paper also reports short-term surgical outcomes. In the infection-free validation cohort, 17/77 (22.1%) met the composite escalation outcome; colectomy occurred in four admissions during the index hospitalization, and 5/91 (5.5%) underwent colectomy within 90 days.

Performance metrics were reported for the infection-free validation cohort using admission-time measures. Discrimination for the composite outcome was reported as an AUC of 0.89 (95% CI, 0.81–0.95) with bootstrap correction, alongside calibration parameters (intercept 0.26; slope 1.29) and overall accuracy (Brier score 0.11). Using the prespecified cutoff of ASUC ≥2, the authors report sensitivity of 94% and specificity of 78%. In a prespecified rescue-only sensitivity analysis (medical rescue therapy alone), the authors report AUC 0.86 (95% CI, 0.77–0.94), with sensitivity 93%, specificity 76%, and negative predictive value of 98% at the same cutoff.

In a head-to-head comparison with the Oxford Day‑3 criterion, ASUC ≥2 identified 16 of 17 eventual non-responders (94%) versus 8 of 17 (47%) by Oxford in this cohort. Decision-curve analysis was described as showing net benefit for ASUC across approximately 10–70% threshold probabilities, with consistent net benefit highlighted between 30% and 50%.