Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2023; 29(48): 6208-6221
Published online Dec 28, 2023. doi: 10.3748/wjg.v29.i48.6208
Clinical value of the Toronto inflammatory bowel disease global endoscopic reporting score in ulcerative colitis
Xin-Yue Liu, Zi-Bin Tian, Li-Jun Zhang, Ai-Ling Liu, Xiao-Fei Zhang, Jun Wu, Xue-Li Ding
Xin-Yue Liu, Zi-Bin Tian, Ai-Ling Liu, Jun Wu, Xue-Li Ding, Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Li-Jun Zhang, Department of Population and Quantitative Health Sciences (PQHS), School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
Xiao-Fei Zhang, Department of Gastroenterology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao 266011, Shandong Province, China
Author contributions: Ding XL, Liu XY, and Tian ZB designed this study; Zhang LJ evaluated and reviewed the statistical methods; Ding XL, Liu XY, Liu AL, Zhang XF, and Wu J collected data; Liu XY analysed the data; Liu XY edited the manuscript; Ding XL, Liu AL, Tian ZB revised the manuscript; and all authors have read and approved the final manuscript.
Supported by Clinical Medicine + X Research Project of the Affiliated Hospital of Qingdao University in 2021, No. QDFY+X202101036; Qingdao Medical and Health Research Program in 2021, No. 2021-WJZD166; and Youth Project of Natural Science Foundation of Shandong Province, No. ZR2020QH031.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (Approval No. QYFY WZLL 28085).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no potential conflicts of interest related to this study.
Data sharing statement: The data used in this study can be obtained from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE statement, and the manuscript was revised in accordance with the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Li Ding, PhD, Associate Professor, Department of Gastro-enterology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266003, Shandong Province, China. dingxueli@qdu.edu.cn
Received: October 10, 2023
Peer-review started: October 10, 2023
First decision: November 6, 2023
Revised: November 25, 2023
Accepted: December 12, 2023
Article in press: December 12, 2023
Published online: December 28, 2023
Processing time: 77 Days and 14.9 Hours
Abstract
BACKGROUND

Endoscopic evaluation in diagnosing and managing ulcerative colitis (UC) is becoming increasingly important. Several endoscopic scoring systems have been established, including the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score and Mayo Endoscopic Subscore (MES). Furthermore, the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting (TIGER) score for UC has recently been proposed; however, its clinical value remains unclear.

AIM

To investigate the clinical value of the TIGER score in UC by comparing it with the UCEIS score and MES.

METHODS

This retrospective study included 166 patients with UC who underwent total colonoscopy between January 2017 and March 2023 at the Affiliated Hospital of Qingdao University (Qingdao, China). We retrospectively analysed endoscopic scores, laboratory and clinical data, treatment, and readmissions within 1 year. Spearman’s rank correlation coefficient, receiver operating characteristic curve, and univariate and multivariable logistic regression analyses were performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, United States) and GraphPad Prism version 9.0.0 for Windows (GraphPad Software, Boston, Massachusetts, United States).

RESULTS

The TIGER score significantly correlated with the UCEIS score and MES (r = 0.721, 0.626, both P < 0.001), showed good differentiating values for clinical severity among mild, moderate, and severe UC [8 (4–112.75) vs 210 (109–219) vs 328 (219–426), all P < 0.001], and exhibited predictive value in diagnosing patients with severe UC [area under the curve (AUC) = 0.897, P < 0.001]. Additionally, the TIGER (r = 0.639, 0,551, 0.488, 0.376, all P < 0.001) and UCEIS scores (r = 0.622, 0,540, 0.494, and 0.375, all P < 0.001) showed stronger correlations with laboratory and clinical parameters, including C-reactive protein, erythrocyte sedimentation rate, length of hospitalisation, and hospitalisation costs, than MES (r = 0.509, 0,351, 0.339, and 0.270, all P < 0.001). The TIGER score showed the best predictability for patients' recent advanced treatment, including systemic corticosteroids, biologics, or immunomodulators (AUC = 0.848, P < 0.001) and 1-year readmission (AUC = 0.700, P < 0.001) compared with the UCEIS score (AUC = 0.762, P < 0.001; 0.627, P < 0.05) and MES (AUC = 0.684, P < 0.001; 0.578, P = 0.132). Furthermore, a TIGER score of ≥ 317 was identified as an independent risk factor for advanced UC treatment (P = 0.011).

CONCLUSION

The TIGER score may be superior to the UCIES score and MES in improving the accuracy of clinical disease severity assessment, guiding therapeutic decision-making, and predicting short-term prognosis.

Keywords: Ulcerative colitis; Toronto Inflammatory Bowel Disease Global Endoscopic Reporting score; Ulcerative Colitis Endoscopic Index of Severity; Mayo Endoscopic Subscore; Endoscopy; Severity

Core Tip: The manuscript introduces the clinical value of the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting (TIGER) score for ulcerative colitis (UC). Our study, for the first time, validated that the TIGER score accurately reflects disease activity and is significantly correlated with laboratory parameters in patients with UC. We also defined TIGER score thresholds for upgraded treatment and 1-year readmission, providing treatment strategies and personalised disease management for patients with UC.