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Predictors of proctocolectomy in children with ulcerative colitis
Lorraine I Kelley-Quon1, Howard C Jen, David A Ziring
1Mattel Children's Hospital, CA, USA.
Insights
Predictors for proctocolectomy in pediatric ulcerative colitis (UC) include hypoalbuminemia, weight loss, family history, and calcineurin inhibitor use. Early identification aids in shaping treatment and multidisciplinary care for children with UC.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Predictors in Pediatrics
Background:
- Ulcerative colitis (UC) in children can necessitate surgical intervention, but clinical predictors for definitive proctocolectomy are not well-established.
- Identifying early indicators for surgery is crucial for optimizing treatment strategies in pediatric UC patients.
Purpose of the Study:
- To identify clinical predictors associated with the need for definitive proctocolectomy in children diagnosed with ulcerative colitis (UC).
- To utilize a specialized pediatric inflammatory bowel disease database for comprehensive analysis.
Main Methods:
- Children diagnosed with UC before age 18 were identified from the Pediatric Inflammatory Bowel Disease Consortium (PediIBDC) database.
- Demographic and clinical data from January 1999 to November 2003 were extracted, including surgical outcomes.
Main Results:
- Of 406 pediatric UC patients, 14% (57) underwent surgery, with a median time of 3.8 years post-diagnosis.
- Predictors for earlier surgical intervention included weight loss (HR 2.55), serum albumin <3.5 g/dL (HR 6.05), and a family history of UC (HR 1.81).
- Treatment with cyclosporine (HR 6.11) or tacrolimus (HR 3.66) also correlated with earlier surgical management.
Conclusions:
- Hypoalbuminemia, weight loss, family history of UC, and treatment with calcineurin inhibitors are significant predictors for proctocolectomy in pediatric UC.
- Early recognition of these factors is vital for tailoring treatment goals and initiating multidisciplinary care upon diagnosis.
Objectives:
Few clinical predictors are associated with definitive proctocolectomy in children with ulcerative colitis (UC). The purpose of the present study was to identify clinical predictors associated with surgery in children with UC using a disease-specific database.
Methods:
Children diagnosed with UC at age <18 years were identified using the Pediatric Inflammatory Bowel Disease Consortium (PediIBDC) database. Demographic and clinical variables from January 1999 to November 2003 were extracted alongside incidence and surgical staging.
Results:
Review of the PediIBDC database identified 406 children with UC. Approximately half were girls (51%) with an average age at diagnosis of 10.6 ± 4.4 years in both boys and girls. Average follow-up was 6.8 (±4.0) years. Of the 57 (14%) who underwent surgery, median time to surgery was 3.8 (interquartile range 4.9) years after initial diagnosis. Children presenting with weight loss (hazard ratio [HR] 2.55, 99% confidence interval [CI] 1.21-5.35) or serum albumin <3.5 g/dL (HR 6.05, 99% CI 2.15-17.04) at time of diagnosis and children with a first-degree relative with UC (HR 1.81, 99% CI 1.25-2.61) required earlier surgical intervention. Furthermore, children treated with cyclosporine (HR 6.11, 99% CI 3.90-9.57) or tacrolimus (HR 3.66, 99% CI 1.60-8.39) also required earlier surgical management. Other symptoms, laboratory tests, and medical therapies were not predictive for need of surgery.
Conclusion:
Children with UC presenting with hypoalbuminemia, weight loss, a family history of UC, and those treated with calcineurin inhibitors frequently require restorative proctocolectomy for definitive treatment. Early identification and recognition of these factors should be used to shape treatment goals and initiate multidisciplinary care at the time of diagnosis.
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