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

J Crohns Colitis. 2024 Feb 26;18(2):286-290.doi: 10.1093/ecco-jcc/jjad148.


Rebecca K Grant 1Gareth-Rhys Jones 1Nikolas Plevris 1Ruairi W Lynch 1 2William M Brindle 1 3Hayley A Hutchings 4John G Williams 4Laith Alrubaiy 4Alan Watkins 4Charlie W Lees 1Ian D R Arnott 1


Author information

1The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.

2Department of Gastroenterology, Ninewells Hospital, Dundee, UK.

3Department of Gastroenterology, Victoria Hospital, Kirkcaldy, UK.

4School of Medicine, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK.


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.

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