The following article is a part of conference coverage from the Advances in Inflammatory Bowel Diseases 2021 Annual Meeting , held from December 9 to 11, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from AIBD 2021.


In patients with acute severe ulcerative colitis (ASUC), the albumin, C-reactive protein, and endoscopy (ACE) index may be useful for predicting response to treatment with steroids, according to research presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2021 Annual Meeting, held from December 9 to 11, 2021, in Orlando, Florida and virtually.

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Delays in treatment for patients admitted with ASUC have been correlated with increased mortality; thus, it is important to identify those who are at high risk for steroid nonresponse, as they may benefit from earlier second-line treatment or surgical intervention.

The ACE index was recently developed to identify steroid response and includes 3 variables: C-reactive protein (CRP) ≥50 mg/dL, albumin ≤30 g/L, and endoscopic severity (Mayo endoscopic score = 3). Scores range from 0 to 3 points, with an index of 3 being useful for identifying patients with acute UC with a high-risk of steroid nonresponse. Researchers conducted a retrospective study to evaluate the performance of the ACE index in predicting steroid response in consecutive admissions for ASUC between January 2005 and December 2020.

Sixty-five patients were included in the study and of these patients, 78.5% responded to steroids. The researchers found that the mean CRP (P =.01), albumin (P =.02), and endoscopic severity scores (P <.001) at admission were significantly different between responders and nonresponders, as opposed to the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score (P =.32).

The median ACE index was 2. While the ACE index was a predictor of steroid response (area under the curve [AUC], 0.789; P =.001), 50.0% of patients with an index of 3 did not respond to steroids, while 86.3% of patients with an index less than 3 did.

The researchers concluded that although the ACE index is an accurate predictor of steroid response on admission with ASUC, it did not differentiate which high-risk patients would benefit from earlier therapeutic escalation.

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Freitas M, Lima CT, Macedo SV, et al. Identifying high-risk patients with acute severe ulcerative colitis: is the ACE index useful? Presented at: AIBD 2021 Annual Meeting; December 9-11, 2021; Orlando, FL and virtual. Abstract P051.