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Risk of Colectomy in Patients With Pediatric-onset Ulcerative Colitis
Firas Rinawi1, Amit Assa, Rami Eliakim
1Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva Sackler Faculty of Medicine, Tel-Aviv University Department of Gastroenterology, Sheba Medical Center-Tel Hashomer, Tel Aviv Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
Insights
Male sex and severe disease at diagnosis increase colectomy risk in pediatric ulcerative colitis (UC). This study identified key factors to predict which children with UC may need surgery.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Outcomes in Children
Background:
- Colectomy rates and risk factors in pediatric ulcerative colitis (UC) lack consistent data.
- Understanding predictors for colectomy is crucial for managing pediatric UC.
- Long-term follow-up is needed to accurately assess colectomy risk in children with UC.
Purpose of the Study:
- To determine the colectomy rate in a large cohort of pediatric UC patients.
- To identify independent risk factors associated with colectomy in children with UC.
- To provide data for improved clinical decision-making and patient counseling.
Main Methods:
- Retrospective chart review of pediatric UC cases diagnosed between 1981 and 2013.
- Assessment of potential colectomy predictors: age at diagnosis, sex, disease extent, severity indices, and therapeutic regimens.
- Multivariate Cox regression analysis to identify independent risk factors.
Main Results:
- 18% (34 of 188) of pediatric UC patients underwent colectomy.
- Male sex (HR 4.2) and severe disease at diagnosis (PUCAI score ≥65, HR 8.9) were significantly associated with increased colectomy risk.
- Cumulative colectomy probability reached 17% at 10 years from diagnosis.
Conclusions:
- Male sex is an independent risk factor for colectomy in pediatric ulcerative colitis.
- A higher Pediatric Ulcerative Colitis Activity Index (PUCAI) score at diagnosis independently predicts increased colectomy risk.
- These findings aid in identifying high-risk pediatric UC patients who may benefit from closer monitoring or earlier intervention.
Objectives:
Data describing the incidence and risk factors for colectomy in pediatric ulcerative colitis (UC) is inconsistent. Our aim was to describe the colectomy rate and to identify risk factors associated with colectomy in a large cohort of children with UC with long-term follow-up.
Materials And Methods:
We performed a retrospective chart review of pediatric UC cases that were diagnosed at Schneider Children's Medical Center of Israel between 1981 and 2013. Potential predictors for colectomy including age at diagnosis, sex, disease extent, severity indices, and different therapeutic regimens during disease course were assessed.
Results:
Of 188 patients with pediatric onset UC, 34 (18%) underwent colectomy. Median follow-up was 6.9 years (range, 1-30). Kaplan-Meier survival estimates of the cumulative probability for colectomy were 4% at 1 year and 17% at 10 years from diagnosis. Multivariate Cox models showed that male sex (hazard ratio 4.2, P = 0.001) and severe disease at diagnosis reflected by Pediatric Ulcerative Colitis Activity Index score ≥65 (hazard ratio 8.9, P < 0.001) were associated with increased risk for colectomy. Age, disease extent, ethnicity, family history of inflammatory bowel disease, early introduction of immunomodulators, or treatment with antitumor necrosis factor α agent did not affect the risk of colectomy.
Conclusions:
Male sex and higher Pediatric Ulcerative Colitis Activity Index score at diagnosis are independent risk factors for colectomy.
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