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Predicting Outcomes in Pediatric Ulcerative Colitis for Management Optimization: Systematic Review and Consensus
Esther Orlanski-Meyer1, Martine Aardoom2, Amanda Ricciuto3
1Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, the Hebrew University of Jerusalem, Israel.
Insights
Identifying predictors for ulcerative colitis (UC) outcomes in children can improve treatment. Key factors include disease extent and activity scores, which help predict colectomy and acute severe colitis (ASC).
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Prediction Modeling
Background:
- Understanding prognostic factors in ulcerative colitis (UC) is crucial for effective patient management and complication reduction.
- Pediatric UC presents unique challenges in predicting disease course and outcomes.
- Optimizing treatment algorithms requires evidence-based predictors tailored for pediatric populations.
Purpose of the Study:
- To identify evidence-based predictors for various outcomes in pediatric ulcerative colitis (UC).
- To establish consensus on prognostic factors to guide personalized medicine approaches.
- To inform the development of optimized treatment strategies for pediatric UC.
Main Methods:
- Expert consensus was achieved through surveys of 202 pediatric UC specialists.
- A systematic literature review and meta-analysis identified studies on UC outcome predictors.
- Multiple national and international meetings facilitated consensus on evidence-based statements.
Main Results:
- Thirty-one consensus statements were developed for predicting colectomy, acute severe colitis (ASC), chronically active UC, cancer, and mortality.
- Predictors for colectomy include disease extent, Pediatric UC Activity Index score, hemoglobin, hematocrit, albumin, family history, and extraintestinal manifestations.
- Risk factors for malignancy in UC include primary sclerosing cholangitis, longstanding colitis, male sex, and younger age at diagnosis.
Conclusions:
- Evidence-based consensus statements provide valuable predictions for personalized pediatric UC management.
- These findings support a tailored approach to treatment algorithms, aiming to improve patient outcomes.
- The identified predictors can aid clinicians in anticipating disease course and potential complications.
Background & Aims:
A better understanding of prognostic factors in ulcerative colitis (UC) could improve patient management and reduce complications. We aimed to identify evidence-based predictors for outcomes in pediatric UC, which may be used to optimize treatment algorithms.
Methods:
Potential outcomes worthy of prediction in UC were determined by surveying 202 experts in pediatric UC. A systematic review of the literature, with selected meta-analysis, was performed to identify studies that investigated predictors for these outcomes. Multiple national and international meetings were held to reach consensus on evidence-based statements.
Results:
Consensus was reached on 31 statements regarding predictors of colectomy, acute severe colitis (ASC), chronically active pediatric UC, cancer and mortality. At diagnosis, disease extent (6 studies, N = 627; P = .035), Pediatric Ulcerative Colitis Activity Index score (4 studies, n = 318; P < .001), hemoglobin, hematocrit, and albumin may predict colectomy. In addition, family history of UC (2 studies, n = 557; P = .0004), extraintestinal manifestations (4 studies, n = 526; P = .048), and disease extension over time may predict colectomy, whereas primary sclerosing cholangitis (PSC) may be protective. Acute severe colitis may be predicted by disease severity at onset and hypoalbuminemia. Higher Pediatric Ulcerative Colitis Activity Index score and C-reactive protein on days 3 and 5 of hospital admission predict failure of intravenous steroids. Risk factors for malignancy included concomitant diagnosis of primary sclerosing cholangitis, longstanding colitis (>10 years), male sex, and younger age at diagnosis.
Conclusions:
These evidence-based consensus statements offer predictions to be considered for a personalized medicine approach in treating pediatric UC.
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