Clinical variables as prognostic tools in pediatric-onset ulcerative colitis: A retrospective cohort study
✍ Scribed by Jill C. Moore; Kimberly Thompson; Bonnie LaFleur; Linda S. Book; W. Daniel Jackson; Molly A. O'Gorman; Richard E. Black; Earl Downey Jr; Dale G. Johnson; Michael E. Matlak; Rebecka L. Meyers; Eric Scaife; Stephen L. Guthery
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 127 KB
- Volume
- 17
- Category
- Article
- ISSN
- 1078-0998
No coin nor oath required. For personal study only.
✦ Synopsis
Background: Clinical variables may identify a subset of patients with pediatric-onset ulcerative colitis (UC) ( 18 years at diagnosis) at risk for adverse outcomes. We postulated that routinely measured clinical variables measured at diagnosis would predict colectomy in patients with pediatric-onset UC.
Methods:
We conducted a chart review of patients with pediatric-onset UC at a single center over a 10-year period. We compared patients with and without colectomy across several variables, used proportional hazards regression to adjust for potential confounders, and assessed the ability of a UC risk score to predict colectomy.
Results: Among 470 patients with inflammatory bowel disease ICD9-coded encounters, 155 patients had UC and 135 were eligible for analysis. The 1-and 3-year colectomy rates were 16.7% (95% confidence interval [CI]: 11.0%-24.8%) and 35.6% (26.7%-45.4%). White blood cell (WBC) count and hematocrit measured at diagnosis were associated with colectomy at 3 years, even after correcting for potential confounding variables. A UC Risk Score derived from the WBC count and hematocrit was strongly associated with colectomy risk, with a high negative predictive value (NPV) for colectomy at 1 and 3 years (NPV ¼ 0.95 and 0.89, respectively), but low positive predictive value (PPV ¼ 0.22 and 0.38, respectively).
Conclusions:
A risk score calculated from WBC and hematocrit measured at diagnosis was associated with, but incompletely predictive of, colectomy in pediatric-onset UC. These data suggest 1) routinely measured clinical variables may have a prognostic role in risk stratification, and 2) multicenter prospective studies are needed to optimize risk stratification in pediatric UC. Our findings have impact on the design of such studies.
(Inflamm Bowel Dis 2011;17:15-21) Key Words: ulcerative colitis, colectomy, pediatric onset U lcerative colitis (UC) is a chronic inflammatory disease with variable tempo, severity, and response to treatment affecting the large intestine. Pediatric-onset UChere defined as age of onset 18 years or younger-is less common in children than adults, with North American prevalence rates varying from 19.7/100,000 to 28/ 100,000. 1,2 Pediatric-onset UC differs from adult-onset disease in several ways. First, young patients with UC typically have a more severe disease course characterized by a higher proportion of extensive disease and a requirement for early addition of immune modulating medications. Second, young patients utilize healthcare resources differently than adults. 6 Third, children are probably at increased risk for age-dependent adverse events of potent immune suppression, particularly Epstein-Barr virus (EBV)-mediated lymphoproliferative disorders. In light of these observations, children and adolescents with UC must be considered a unique clinical subgroup.
In this study we hypothesized that variables routinely measured at diagnosis can predict colectomy in pediatriconset UC. This hypothesis was motivated by several factors. First, it is desirable to identify young UC patients at risk for adverse outcomes early in the course of their disease. The ability to identify high-risk patients would allow clinicians to inform families about the likelihood of adverse outcomes, and potentially introduce disease-modifying therapies early in the disease course to those who may benefit. Second, several clinical variables are routinely measured at diagnosis and there are limited data as to