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Predicting Outcomes in Pediatric Crohn's Disease for Management Optimization: Systematic Review and Consensus
Amanda Ricciuto1, Martine Aardoom2, Esther Orlanski-Meyer3
1IBD Centre, SickKids Hospital, University of Toronto, Toronto, Canada.
Insights
Identifying prognostic factors in pediatric Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Pediatric Crohn's disease (CD) is a heterogeneous condition requiring better understanding of prognostic factors.
- Optimizing patient management and reducing complications are key goals in pediatric CD care.
Purpose of the Study:
- To identify evidence-based predictors of outcomes in pediatric Crohn's disease.
- To establish consensus statements on prognostic factors for improved patient management.
Main Methods:
- Survey of 202 pediatric CD experts to identify adverse outcomes.
- Systematic literature review and meta-analysis of clinical studies on outcome predictors.
- Consensus meetings to develop evidence-based statements.
Main Results:
- 27 consensus statements on prognostic factors for surgery, complications, chronic activity, and hospitalization.
- Identified predictors for surgery include adolescent diagnosis, growth impairment, NOD2/CARD15, disease behavior, and serology.
- Risk factors for complicated disease (B2/B3) include age, small bowel involvement, serology, NOD2/CARD15, perianal disease, and ethnicity.
Conclusions:
- Evidence-based consensus statements provide insights into pediatric CD outcome predictors.
- These statements aid in developing treatment algorithms and guiding future research.
- Further longitudinal studies are needed to refine prognostic factors and evaluate tailored treatments.
Background & Aims:
A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management.
Methods:
A survey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence.
Results:
Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density.
Conclusions:
These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk.
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