P773 Patient reported outcomes, partial MAYO score and SCCAI are equally accurate in predicting mucosal healing in UC: Preliminary results from a prospective study

P. Golovics1, L. Gonczi2, J. Reinglass3, C. Verdon3, W. Afif3, G. Wild3, A. Bitton3, E. Seidman3, T. Bessissow3, P.L. Lakatos PhD2,3

1Medical Centre- Hungarian Defence Forces, Division of Gastroenterology, Budapest, Hungary, 2Semmelweis University, 1st Department of Medicine, Budapest, Hungary, 3McGill University, Division of Gastroenterology, Montreal, Canada

Background

Optimal management of patients with ulcerative colitis (UC) requires the accurate assessment of disease activity. Endoscopic evaluation is considered the gold standard approach, but it is invasive. We aimed to determine how strong patient reported outcomes, clinical scores and symptoms correlate with endoscopy for assessment of disease activity in UC patients.

Methods

One hundred and thirty-six patients were included prospectively (age: 48 (IQR: 38–61) years, duration 12 (4–19) years, 63 females, 53.7% extensive disease, 40.4% on biologicals) at the time of the colonoscopy. The 2 item patient reported outcome (PRO), partial MAYO, Simple Clinical Colitis Activity Index (SCCAI), Mayo endoscopic subscore (MES), Baron and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores were calculated. C reactive Protein (CRP) and fecal calprotectin (FCAL) was available in 58.1 and 33.8% of patients. 20.7% had clinical flare, treatment was escalated in 17.8% of patients. Sensitivity, specificity, PPV and NPV values were calculated, ROC analysis and K-statistics were performed.

Results

Rectal bleeding(RBS), stool frequency(SF) subscore of 0, or total PRO2 remission(RBS0 and SF≤1), partial MAYO(≤2) and SCCAI(≤2.5) remission were similarly associated to mucosal healing defined by MES(0 or ≤1) or Baron (0 or ≤1) scores (Table 1). PRO2 remission (AUCMES0/Baron0:0.747/0.715, AUCMES0-1/Baron0-1:0.867/0.863), SF AUCMES0/Baron0:0.731/0.703, AUCMES0-1/Baron0-1:0851/0.839), RBS(AUCMES0/Baron0:0.708/0.685, AUCMES0-1/Baron0-1:0.828/0.835) partial Mayo (AUCMES0/Baron0:0.792/0.755, AUCMES0-1/Baron0-1:0.917/0.903) and SCCAI (AUCMES0/Baron0:0.738/0.724, AUCMES0-1/Baron0-1:0.908/0.880) were similarly associated with mucosal healing in a ROC analysis. There was a string association between MES and Baron (k=0.798), while moderate agreement between UCEIS and MES (K=0.451) or Baron (K=0.499) scores. Agreement between CRP and clinical remission or endoscopic healing (MES/Baron) was poor (K~0.2), while agreement between FCAL (>100 or >250) and RBS-PRO2 remission (K>250:0.56–0.61) or MES/Baron 0 was moderate to good(K>100:0.54-0.53 and K>250:0.50–0.54)

SensitivitySpecificityPPVNPV
PRO RBS 0 vs. MES 097.5%43.3%72.2%92%
PRO RBS 0 vs. MES ≤196.1%67.7%90.7%84%
PRO RBS 0 vs. Baron 097.3%39%66.7%92%
PRO RBS 0 vs. Baron ≤192.7%70.8%93.5%68%
PRO2 remission vs. MES 096.2%47.2%73.3%89.3%
PRO2 remission vs. MES ≤195.1%74.2%92.4%82.1%
PRO2 remission vs. Baron 095.9%42.4%67.6%89.3%
PRO2 remission vs. Baron ≤190.8%75%94.3%64.3%

Conclusion

We found no difference across accuracy of RBS, SF, PRO2, partial Mayo and SCCAI in predicting endoscopic healing. A strong association was found with high PPV for MES/Baron ≤1 and high NPV for MES/Baron 0. FCAL, but not CRP was associated to clinical and endoscopic remission.