Distinct predictive factors for acute severe ulcerative colitis in East Asian and Western populations

Abstract Background This study aimed to develop predictive models for acute severe ulcerative colitis (ASUC) using data from East Asian (EA) patients and to validate their performance in an Australia/New Zealand (ANZ) cohort. Methods A retrospective international study was conducted across 23 referral hospitals in EA and ANZ, enrolling consecutive ASUC patients between January 2015 and December 2022. Logistic regression analyses were used to construct predictive models for 1-year colectomy and non-response to corticosteroid therapy (NRS). Results Overall, 826 patients with ASUC were included (411 EA and 415 ANZ). Among EA patients, independent predictors of 1-year colectomy included female sex, prior exposure to tumor necrosis factor inhibitors, and admission albumin ≤3 g/dL. Independent predictors of NRS in the EA cohort were age at diagnosis  ≤37 years, baseline steroid use, admission albumin ≤2.5 g/dL, and the presence of extraintestinal manifestations. The EA-derived scoring systems demonstrated strong predictive performance within the EA cohort (1-year colectomy: P  Conclusions Predictive factors for ASUC differ substantially between EA and ANZ patients, highlighting the need for population-specific predictive tools.