Early endoscopic, laboratory and clinical predictors of poor disease course in paediatric ulcerative colitis
| Autor: | Tali Bdolah-Abram, Amir Schechter, Ron Shaoul, Oren Ledder, Raanan Shamir, Dan Turner, Eyal Shteyer, Christopher E.M. Griffiths, Juan Cristóbal Gana |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Disease Cohort Studies Internal medicine medicine Humans Colitis Child Retrospective Studies Colectomy Receiver operating characteristic biology medicine.diagnostic_test business.industry C-reactive protein Gastroenterology Colonoscopy Prognosis medicine.disease Ulcerative colitis Surgery Early Diagnosis Erythrocyte sedimentation rate Ambulatory Disease Progression biology.protein Colitis Ulcerative Female business |
| Zdroj: | Gut. 64:580-588 |
| ISSN: | 1468-3288 0017-5749 |
| Popis: | Data to support treatment algorithms in ambulatory paediatric UC are scarce. We aimed to explore the 1 year outcome in an inception cohort of paediatric UC patients and to identify early predictors of good outcome that might serve as short term treatment targets.A chart review of 115 children with new onset UC was performed (age 11 ± 4.1 years; 58 (50%) males; 86 (75%) extensive colitis; 70 (61%) moderate-severe disease; 63 (55%) received steroids at baseline). We assessed the Paediatric Ulcerative Colitis Activity Index (PUCAI) and laboratory variables at the time of diagnosis and at 3 months, and endoscopy at diagnosis.The 3 month PUCAI was the strongest predictor of 1 year sustained steroid free remission (SSFR) (area under the receiver operating characteristic curve (AUROC)=0.7 (95% CI 0.6 to 0.8) and colectomy by 2 years (AUROC=0.75 (0.6 to 0.89)). SSFR was achieved in 9/54 (17%) children who had active disease (PUCAI ≥ 10) at 3 months (negative predictive value (NPV)=83%) and by 4/46 (8.6%) of those with a PUCAI score10; (NPV=91%, positive predictive value=52%; p0.001), implying that PUCAI10 at 3 months has a probability of 9% for achieving SSFR versus 48% with a PUCAI value of ≤10. None of the variables at baseline was predictive of SSFR or colectomy (endoscopic severity, disease extent, age, PUCAI or C reactive protein/erythrocyte sedimentation rate/albumin/haemoglobin; all AUROC0.6, p0.05) but baseline PUCAI predicted subsequent acute severe colitis and the need for salvage medical therapy.Completeness of the early response appears more important than baseline UC severity for predicting outcome in children, and supports using PUCAI10 as a feasible treatment goal. Our data suggest that treatment escalation should be considered with a PUCAI value of ≥ 10 at 3 months. |
| Databáze: | OpenAIRE |
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