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Early Response to Corticosteroid and Baseline C-Reactive Protein Predicts Outcomes in Children with Moderate to
Gayetri Deva Rajoo1, Lian Tan1, Ainslie Lopez1
1Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia.
Insights
Children with ulcerative colitis (UC) who do not respond well to initial corticosteroids (CS) face worse outcomes, including higher rates of colectomy. Early identification of poor responders (PR) is crucial for predicting long-term UC prognosis.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Outcomes Analysis
Background:
- Initial corticosteroid (CS) response is a key predictor of outcomes in pediatric ulcerative colitis (UC).
- Understanding the long-term implications of early CS response is vital for managing UC in children.
Purpose of the Study:
- To compare the longitudinal outcomes of early poor responders (PR) versus good responders (GR) to initial CS in children with moderate-to-severe UC.
- To evaluate outcomes at 1, 2, and 3 years post-diagnosis based on initial CS response.
Main Methods:
- Retrospective analysis of pediatric patients with moderate-to-severe UC initiating oral/IV CS within one month of diagnosis.
- Defined PR as CS resistance (CSR) or CS dependency (CSD); GR achieved CS-free remission (CSFR) at 6 months.
- Minimum follow-up of 1 year, with outcomes including relapse, acute severe UC flare-ups, and colectomy rates analyzed.
Main Results:
- Poor responders (PR) showed significantly higher rates of relapse (2.39 vs. 1.1), acute severe UC flare-ups (40% vs. 9.7%), and colectomy (34.2% vs. 2.4%) compared to good responders (GR).
- Despite early use of azathioprine and anti-TNFs in PR, colectomy rates at 3 years were substantially higher in PR (CSD: 28%, CSR: 50%) versus GR (2.4%).
- Baseline C-reactive protein (CRP) > 20 mg/L and PR predicted colectomy on univariate analysis, but only baseline CRP > 20 mg/L remained a significant predictor on multivariate regression.
Conclusions:
- Initial poor response to corticosteroids (CS) and elevated baseline C-reactive protein (CRP) are associated with unfavorable long-term outcomes in pediatric ulcerative colitis (UC).
- Early identification of poor CS responders is critical for risk stratification and potentially guiding more aggressive therapeutic strategies in pediatric UC.
Background:
Initial response to corticosteroids (CS) is recognized as a strong predictor of outcomes in ulcerative colitis (UC).
Aim:
To compare outcomes of early poor responders (PR) versus good responders (GR) to initial CS at 1, 2, and 3 years from diagnosis.
Methods:
In this retrospective study, we report longitudinal outcomes of children with moderate-severe UC, initiating oral/IV CS < 1 month of diagnosis and a minimum follow-up (FU) of 1 year. CS resistance (CSR) and CS dependency (CSD) were combined as PR, and those with CS-free remission (CSFR) at 6 months were GR.
Results:
Of 116 children with UC, 76 (33 males) fulfilled study criteria. Median age at diagnosis was 12 years (IQR 12-14), and a median FU was 48 months (IQR 27-65). Thirty-five (46%, CSR = 10, CSD = 25) were PR, and 41 (54%) were GR. Mean relapse (2.39 vs. 1.1, p = 0.0009), acute severe UC flare-up (40% vs. 9.7%, p = 0.002), and colectomy rates (34.2% vs. 2.4%) were greater in PR versus GR, despite frequent early (< 6 months) use of azathioprine (74% vs. 27%, p = 0.004) and anti-TNFs (43% vs. 2.4%, p = 0.0001). Cumulative colectomy at 3 years was lowest in those with GR versus CSD and CSR (2.4% vs. 28% and 50% p = 0.001). On univariate analysis, CRP > 20 mg/L at diagnosis, Mayo Clinical Score > 1 at 3 months, and PR predicted colectomy. On multivariate regression, only baseline CRP > 20 mg/L predicted colectomy (HR 4.9, p = 0.03).
Conclusions:
Baseline CRP and poor response to initial CS are associated with unfavorable outcomes in children with UC.
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