title: Clinical variables as prognostic tools in pediatric-onset ulcerative colitis: a retrospective cohort study.
abstract: 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 = 0.95 and 0.89, respectively), but low positive predictive value (PPV = 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.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Jill C
authors.initials: JC
authors.lastname: Moore
authors.forename: Kimberly
authors.initials: K
authors.lastname: Thompson
authors.forename: Bonnie
authors.initials: B
authors.lastname: Lafleur
authors.forename: Linda S
authors.initials: LS
authors.lastname: Book
authors.forename: W Daniel
authors.initials: WD
authors.lastname: Jackson
authors.forename: Molly A
authors.initials: MA
authors.lastname: O'Gorman
authors.forename: Richard E
authors.initials: RE
authors.lastname: Black
authors.forename: Earl
authors.initials: E
authors.lastname: Downey
authors.forename: Dale G
authors.initials: DG
authors.lastname: Johnson
authors.forename: Michael E
authors.initials: ME
authors.lastname: Matlak
authors.forename: Rebecka L
authors.initials: RL
authors.lastname: Meyers
authors.forename: Eric
authors.initials: E
authors.lastname: Scaife
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Guthery
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery; D006801:Humans; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors