Endoscopic and histologic activity assessment considering disease extent and prediction of treatment failure in ulcerative colitis

Abstract

Background and Aims

DUBLIN score allows evaluation of disease activity and extent in ulcerative colitis (UC). This study aimed to evaluate DUBLIN score as a predictor of therapeutic failure as well as to associate endoscopic and histological activity scores to assess their joint performance.

Methods

Retrospective cohort study, with consecutive inclusion of patients undergoing total colonoscopy with serial biopsies between 2016 and 2019. DUBLIN score (0–9) was calculated as the product of Mayo endoscopic score (MSe 0–3) by disease extent (E1–E3). Histological activity was evaluated through Nancy score (0–4). Activity scores were correlated with biomarkers, treatment failure (therapeutic escalation, hospitalization and/or colectomy) and clinical remission at 6 months (Mayo partial score ≤ 1).

Results

One-hundred and seven patients were included. In 38.3% (n = 41) there was evidence of endoscopic activity (MSe ≥ 2) and in 50.5% (n = 54) histological activity (Nancy ≥ 2). MSe and DUBLIN scores showed good correlation (r = 0.943; p < .001) and both were significantly higher in patients with histological activity (p < .001). Therapeutic failure occurred in 25.2% (n = 27). MSe, DUBLIN, and Nancy scores were significantly associated with therapeutic failure (p < .001). The areas under the (AUC) ROC curve were 0.74 (MSe; p < .001), 0.78 (DUBLIN; p < .001) and 0.84 (Nancy; p < .001). Joint evaluation of endoscopic and histological activity by combining DUBLIN and Nancy scores was associated with therapeutic failure with a significantly higher AUC of 0.84 (p < .001) compared to the Dublin score alone (p = .003).

Conclusion

Mayo and DUBLIN endoscopic scores correlated with each other and with histological activity. The joint evaluation of endoscopic and histological activity allowed to predict with greater accuracy treatment failure.

Keywords:

• Ulcerative colitis
• Inflammatory burden
• mucosal healing
• endoscopic activity
• histologic activity
• treatment failure

Acknowledgements

Silva JC wrote the manuscript. Silva JC, Fernandes Cand Rodrigues J designed the study. Carvalho J revised the paper critically for important intellectual content. Fernandes S and Ponte A performed the procedures and assessed endoscopic activity. Rodrigues A, Silva AP, Gomes AC, Afecto E and Correia J participated in the research and data analysis. All authors approved the final version of the manuscript.

Author contributions

Silva JC, Fernandes C and Rodrigues J designed the study, performed the research, analysed the data and wrote the paper. Rodrigues A, Silva AP, Ponte A, Gomes AC, Afecto E, Correia J, the performed the research and analysed data. Carvalho J revised the paper critically for important intellectual content.

Disclosure of interest

The authors report no conflict of interest.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.