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Predictors of Complicated Disease Course in Children and Adults With Ulcerative Colitis: A Nationwide Study From the
Ohad Atia1, Rachel Buchuk1, Rona Lujan1
1Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.
Insights
Predictors of complicated ulcerative colitis (UC) include younger age, extraintestinal manifestations, and specific induction therapies. Pediatric-onset UC has a higher risk of complicated disease course within five years.
Area of Science:
- Gastroenterology
- Clinical Epidemiology
- Inflammatory Bowel Disease Research
Background:
- Limited data exists on predictors for complicated ulcerative colitis (UC) courses in unselected populations.
- Understanding these predictors is crucial for early intervention and improved patient outcomes.
- Nationwide cohorts offer a valuable resource for identifying such predictors.
Purpose of the Study:
- To identify predictors at diagnosis for complicated disease course in pediatric and adult UC patients.
- To analyze the association between baseline laboratory markers and disease severity.
- To compare disease course probabilities between pediatric-onset and adult-onset UC.
Main Methods:
- Utilized the nationwide epi-IIRN cohort data for patients diagnosed with UC since 2005.
- Defined complicated disease course as colectomy, steroid-dependency, or need for biologic drugs.
- Employed hierarchical clustering on complete blood count, albumin, C-reactive protein, and ESR to categorize disease severity at diagnosis.
Main Results:
- Included 13,471 UC patients (1427 pediatric-onset) with 103,212 person-years follow-up.
- Complicated disease course occurred in 21% of patients; 5-year probabilities were 32% for pediatric-onset vs. 16% for adult-onset UC.
- Cox model identified steroid induction therapy, extraintestinal manifestations, and severe lab clusters as predictors of complicated course; enema induction and older age were protective.
Conclusions:
- The 5-year probability of a complicated UC course is significantly higher in pediatric-onset disease.
- Routinely collected laboratory tests, younger age at diagnosis, extraintestinal manifestations, and induction therapy type are key predictors.
- These findings highlight the importance of early risk stratification in UC management.
Background:
Data on predictors of complicated ulcerative colitis (UC) course from unselected populations cohorts are scarce. We aimed to utilize a nationwide cohort to explore predictors at diagnosis of disease course in children and adults with UC.
Methods:
Data of patients diagnosed with UC since 2005 were retrieved from the nationwide epi-IIRN cohort. Complicated disease course was defined as colectomy, steroid-dependency, or the need for biologic drugs. Hierarchical clustering categorized disease severity at diagnosis based on complete blood count, albumin, C-reactive protein and erythrocyte sedimentation rate (ESR), analyzed together.
Results:
A total of 13 471 patients with UC (1427 [11%] pediatric-onset) including 103 212 person-years of follow-up were included. Complicated disease course was recorded in 2829 (21%) patients: 1052 (7.9%) escalated to biologics, 1357 (10%) experienced steroid-dependency, and 420 (3.1%) underwent colectomy. Probabilities of complicated disease course at 1 and 5 years from diagnosis were higher in pediatric-onset (11% and 32%, respectively) than adult-onset disease (4% and 16%; P < .001). In a Cox multivariate model, complicated course was predicted by induction therapy with steroids (hazard ratio [HR], 1.5; 95% CI, 1.2-2.0), extraintestinal manifestations (HR, 1.3; 95% CI, 1.03-1.5) and the disease severity clusters of blood tests (HR, 1.8; 95% CI, 1.01-3.1), while induction therapy with enemas (HR, 0.6; 95% CI, 0.5-0.7) and older age (HR, 0.99; 95% CI, 0.98-0.99) were associated with noncomplicated course.
Conclusion:
In this nationwide cohort, the probability of complicated disease course during the first 5 years from diagnosis was 32% in pediatric-onset and 16% in adults with UC and was associated with more severe clusters of routinely collected laboratory tests, younger age at diagnosis, extraintestinal manifestations, and type of induction therapy.
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