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Predicting complications in paediatric ulcerative colitis: A longitudinal multicentre cohort study
Merle Claßen1, Benjamin Schiller2, Jan Däbritz3,4
1Department of Paediatrics, Erlangen University Medical Centre, Erlangen, Germany.
Insights
Predictors of poor outcomes in pediatric ulcerative colitis (UC) were validated. Older age, higher disease activity, upper GI involvement, and low hematocrit predict complications, aiding early treatment strategies for pediatric UC patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Preventing complications in pediatric ulcerative colitis (UC) requires understanding outcome predictors.
- Previous research identified potential predictors, necessitating external validation in larger patient groups.
Purpose of the Study:
- To investigate and validate predictors of poor outcomes in pediatric UC patients.
- To identify clinical and biochemical markers associated with disease progression and treatment escalation.
Main Methods:
- Analysis of 743 pediatric UC patients from the German-Austrian CEDATA-GPGE registry.
- Utilized Cox regressions, Kaplan-Meier estimator, and ROC curve analyses.
- Examined predictors for relapse, hospitalization, therapy escalation, and specific treatment needs.
Main Results:
- Older age at diagnosis correlated with relapse, hospitalization, and intensified treatment (immunomodulators, biologics).
- High initial disease activity and upper GI involvement predicted the need for biologics and corticosteroids.
- Elevated fecal calprotectin (>685 μg/g) indicated higher risk for acute severe colitis; lower hematocrit predicted biologic use.
Conclusions:
- This study confirms key predictors for adverse outcomes in pediatric UC.
- Findings empower clinicians to anticipate disease course and implement timely, targeted interventions for better patient management.
Background:
To prevent complications of paediatric ulcerative colitis (UC), it is critical to understand their predictors. The Paediatric Inflammatory Bowel Disease Ahead (PIBD Ahead) program identified the relevant outcomes and their potential predictors. However, external validation of these results in larger cohorts is required.
Aims:
The aim of this study is to investigate these outcomes and their predictors.
Methods:
We included 743 patients aged under 18 years with UC from the multicentre German-Austrian CEDATA-GPGE registry. We performed Cox regressions, Kaplan-Meier estimator, and receiver operating characteristics curve analyses to analyse predictors of poor outcomes.
Results:
Older age at diagnosis was associated with relapse, hospitalisation, the use of immunomodulators, use of biologics, and therapy escalation. Higher disease activity, as in acute severe colitis in the first 3 months, was significantly associated with further acute severe colitis and the need for biologics. Upper gastrointestinal tract involvement was a risk factor for the need of intravenous corticosteroids and biologics. A faecal calprotectin of >685 μg/g was associated with a higher risk of subsequent acute severe colitis with a sensitivity of 79.0% and a specificity of 59.1%. A lower haematocrit at diagnosis was predictive of the use of biologics. Colectomy was rare.
Conclusions:
This study validates predictors of poor outcomes in paediatric patients with UC. Our results might help physicians to anticipate poor outcomes and initiate appropriate treatment strategies at an early stage.
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