LONDON Prediction of corticosteroid failure in Acute Severe Ulcerative Colitis

  IBD, Ulcerative Colitis

LONDON Score for Predicting Corticosteroid Failure in Acute Severe Ulcerative Colitis

The LONDON score is a clinical tool designed to predict the likelihood of corticosteroid failure in patients with Acute Severe Ulcerative Colitis (ASUC). It incorporates various clinical and laboratory parameters to provide an objective risk assessment.

Parameters and Scoring

The LONDON score assigns points based on the following criteria:

  1. Age > 40 years: 2 points
  2. Heart rate > 90 beats/min: 1 point
  3. Hemoglobin < 10.5 g/dL: 1 point
  4. Albumin < 30 g/L: 1 point
  5. CRP > 45 mg/L: 1 point
  6. Stool frequency > 8 per day on day 3 of corticosteroid therapy: 1 point

Interpretation of the Score

  • Total Score ≥ 4: Indicates a high risk of corticosteroid failure, suggesting the need for early consideration of second-line therapies or surgical intervention.
  • Total Score < 4: Indicates a lower risk of corticosteroid failure.

Patients identified as high risk (score ≥ 4) have a significantly increased likelihood of corticosteroid failure. Studies indicate that approximately 60% of patients with ASUC may fail corticosteroid therapy if they are classified as high risk using this score​

References:

Ho, G.T., Mowat, C., Goddard, C.J.R., Fennell, J., Shah, N.B., Prescott, R.J., & Satsangi, J. (2004). Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery. Alimentary Pharmacology & Therapeutics, 19(10), 1079-1087. DOI: 10.1111/j.1365-2036.2004.02010.x