Digestive Diseases and Sciences, Vol. 50, No. 2 (February 2005), pp. 246–251 ( C  2005) DOI: 10.1007/s10620-005-1590-4 Proposal of a New Clinical Index Predictive of Endoscopic Severity in Ulcerative Colitis FRANCESCO AZZOLINI, MD, CRISTIANO PAGNINI, MD, LORENZO CAMELLINI, MD, ANTONELLA SCARCELLI, MD, ALBERTO MERIGHI, MD, ANNA MARIA PRIMERANO, MD, ANGELA BERTANI, MD, ALDO ANTONIOLI, MD, FEDERICO MANENTI, MD, and GIAN PIERO RIGO, MD Assessment of disease activity by clinical parameters in ulcerative colitis is still controversial. Dif- ferent clinical indexes have been proposed. Colonoscopy provides detailed information on mucosal damage. The aim of this study was to identify, among 21 clinical and laboratory parameters, which were predictive of endoscopic activity. We included 137 consecutive patients with ulcerative colitis who underwent colonoscopy, clinical examination, and blood tests within 4 weeks. Endoscopic sever- ity was recorded using a simple score (range, 0–30). The multiple stepwise regression coefficient of each significant variable predictive of mucosal damage was used to develop a new activity index predictive of endoscopic appearance (Endoscopic–Clinical Correlation Index; ECCI). We tested the ability of our score to discriminate patients with severe endoscopic disease, calculating the area under the receiver operator characteristic curve, and we compared it to activity indexes proposed by other authors. Endoscopic severity was significantly influenced by four parameters: bloody stool, noctur- nal bowel movements, body temperature >37.5 ◦ C, and serum albumin. The new scoring system was calculated as ECCI = {[serum albumin × (-26)] + (bloody stool × 17) + (nocturnal bowel movements × 16) + [fever (0 or 1) × 39]} + 107. The ECCI accurately identified patients with severe endoscopic disease in our sample (sensitivity = 81%, specificity = 95%). In conclusion, the ECCI should be useful in clinical practice because it is simple and strongly related to endoscopic activity. KEY WORDS: ulcerative colitis; disease activity; colonoscopy; Endoscopic–Clinical Correlation Index. One of the issues concerning ulcerative colitis (UC) has al- ways been to assess the severity of disease by clinical and laboratory findings that are usually available in clinical practice. During the last 40 years several scoring systems have been proposed for this purpose: Truelove–Witts cate- gories (1), Powell–Tuck score (2), Seo Activity Index (AI) (3), and Simple Clinical Colitis Activity Index (SCCAI) (4) are among the most frequently used. Nevertheless, the question of what parameter should be assessed as the “gold Manuscript received April 12, 2004; accepted August 6, 2004. From the Department of Internal Medicine, Gastrointestinal Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Italy. Address for reprint requests: Cristiano Pagnini, MD, 1800 Jefferson Park Avenue, Apt. 48, Charlottesville, Virginia 22903, USA; cristiano x@libero.it. standard”, that is, what scoring system should be referred to, remains unsolved. Endoscopy should represent that parameter, because it is the most immediate and objective method to assess and quantify intestinal mucosal dam- age, the characteristic anatomic feature underlying this disease. But colonoscopy is invasive and costly, and its use in follow-up should be reserved for patients at high risk for colorectal cancer (5–9) or performed when a worsen- ing clinical picture necessitates endoscopic restaging. It would be useful to be able to identify the clinical or lab- oratory features that are predictive of severe endoscopic disease and perform colonoscopy just in the patients pre- senting those features. This study aimed to verify which among the clinical and laboratory parameters readily available to the physician 246 Digestive Diseases and Sciences, Vol. 50, No. 2 (February 2005) 0163-2116/05/0200-0246/0 C  2005 Springer Science+Business Media, Inc.