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Clinical variables as prognostic tools in pediatric-onset ulcerative colitis: a retrospective cohort study
Jill C Moore1, Kimberly Thompson, Bonnie Lafleur
1Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Insights
A risk score using white blood cell count and hematocrit at diagnosis can help predict colectomy in pediatric ulcerative colitis (UC) patients. Further studies are needed to optimize risk stratification for better patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Outcomes Prediction
Background:
- Pediatric ulcerative colitis (UC) diagnosis at or before age 18 poses risks for adverse outcomes.
- Identifying high-risk patients early is crucial for managing pediatric UC.
- Clinical variables at diagnosis may predict colectomy in pediatric UC.
Purpose of the Study:
- To determine if routinely measured clinical variables at diagnosis can predict colectomy in pediatric-onset UC.
- To assess the predictive ability of a UC risk score for colectomy.
- To evaluate the prognostic role of clinical variables in pediatric UC risk stratification.
Main Methods:
- A 10-year retrospective chart review of pediatric UC patients.
- Comparison of patients with and without colectomy across clinical variables.
- Proportional hazards regression for confounder adjustment.
- Assessment of a UC Risk Score for colectomy prediction.
Main Results:
- 1-year and 3-year colectomy rates were 16.7% and 35.6%, respectively.
- White blood cell (WBC) count and hematocrit at diagnosis predicted 3-year colectomy, even after adjusting for confounders.
- A UC Risk Score based on WBC and hematocrit showed high negative predictive value (NPV=0.95 at 1 year, 0.89 at 3 years) but low positive predictive value (PPV=0.22 at 1 year, 0.38 at 3 years).
Conclusions:
- A risk score derived from WBC and hematocrit at diagnosis is associated with colectomy risk in pediatric UC.
- Routinely measured clinical variables may aid in risk stratification for pediatric UC.
- Multicenter prospective studies are necessary to refine risk stratification models for pediatric UC.
Background:
Clinical variables may identify a subset of patients with pediatric-onset ulcerative colitis (UC) (≤18 years at diagnosis) at risk for adverse outcomes. We postulated that routinely measured clinical variables measured at diagnosis would predict colectomy in patients with pediatric-onset UC.
Methods:
We conducted a chart review of patients with pediatric-onset UC at a single center over a 10-year period. We compared patients with and without colectomy across several variables, used proportional hazards regression to adjust for potential confounders, and assessed the ability of a UC risk score to predict colectomy.
Results:
Among 470 patients with inflammatory bowel disease ICD9-coded encounters, 155 patients had UC and 135 were eligible for analysis. The 1- and 3-year colectomy rates were 16.7% (95% confidence interval [CI]: 11.0%-24.8%) and 35.6% (26.7%-45.4%). White blood cell (WBC) count and hematocrit measured at diagnosis were associated with colectomy at 3 years, even after correcting for potential confounding variables. A UC Risk Score derived from the WBC count and hematocrit was strongly associated with colectomy risk, with a high negative predictive value (NPV) for colectomy at 1 and 3 years (NPV = 0.95 and 0.89, respectively), but low positive predictive value (PPV = 0.22 and 0.38, respectively).
Conclusions:
A risk score calculated from WBC and hematocrit measured at diagnosis was associated with, but incompletely predictive of, colectomy in pediatric-onset UC. These data suggest 1) routinely measured clinical variables may have a prognostic role in risk stratification, and 2) multicenter prospective studies are needed to optimize risk stratification in pediatric UC. Our findings have impact on the design of such studies.
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