We would like to congratulate Adams et al on the paper addressing the important issue regarding the development of prognostic clinical indexes for patients with acute severe ulcerative colitis (ASUC) leading to the development of the ADMIT-ASC score.1

Although we acknowledge the initiative, the development of a static prognostic index might be reconsidered with the increased availability and use of noninvasive and real-time cross-sectional imaging.

Recently, we investigated the use of intestinal ultrasound (IUS) to measure early changes in the sigmoid bowel wall thickness (BWT) as an indicator of intravenous corticosteroid (CS) response in patients admitted with ASUC. A >20% reduction in BWT after 48 hours predicted CS response within 7 days (p<0.0001 for pMayo response, p=0.006 for no need of rescue therapy) and was superior to CRP, albumin or pMayo response at 48 hours in multivariate analysis.2

With C-reactive protein (CRP), albumin and endoscopic severity scores being major components of the ADMIT-ASC score, we set out to apply this score to our cohort and indeed we did find a good correlation with CS-response across the different ADMIT-ASC scores between the Ilvemark …