title: Clinical predictors at diagnosis of disabling pediatric Crohn's disease.
abstract: BACKGROUND
  Identification of children with Crohn's disease (CD) at high risk of disabling disease would be invaluable in guiding initial therapy. Our study aimed to identify predictors at diagnosis of a subsequent disabling course in a population-based cohort of patients with pediatric-onset CD.
  
  
  METHODS
  Among 537 patients with pediatric CD diagnosed at <17 years of age, 309 (57%) with 5-year follow-up were included. Clinical and demographic factors associated with subsequent disabling CD were studied. Three definitions of disabling CD were used: Saint-Antoine and Liège Hospitals' definitions and a new pediatric definition based on the presence at maximal follow-up of: 1) growth delay defined by body mass index (BMI), weight or height lower than -2 SD Z score; and 2) at least one intestinal resection or two anal interventions. Predictors were determined using multivariate analyses and their accuracy using the kappa method considering a relevant value ≥ 0.6.
  
  
  RESULTS
  According to the Saint-Antoine definition, the rate of disabling CD was 77% and predictors were complicated behavior and L1 location. According to the Liège definition, the rate was 37% and predictors included behavior, upper gastrointestinal disease, and extraintestinal manifestations. According to the pediatric definition, the rate of disabling CD was 15%, and predictors included complicated behavior, age <14, and growth delay at diagnosis. Kappa values for each combination of predictors were, respectively, 0.2, 0.3, and 0.2 and were nonrelevant.
  
  
  CONCLUSIONS
  Clinical parameters at diagnosis are insufficient to predict a disabling course of pediatric CD. More complex models including serological and genetic biomarkers should be tested.
authors.affiliation: Gastroenterology Unit, EPIMAD Registry, Rouen University and Hospital, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Savoye
authors.forename: Julia
authors.initials: J
authors.lastname: Salleron
authors.forename: Corinne
authors.initials: C
authors.lastname: Gower-Rousseau
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Dupas
authors.forename: Gwénola
authors.initials: G
authors.lastname: Vernier-Massouille
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.forename: Véronique
authors.initials: V
authors.lastname: Merle
authors.forename: Eric
authors.initials: E
authors.lastname: Lerebours
authors.forename: Antoine
authors.initials: A
authors.lastname: Cortot
authors.forename: Dominique
authors.initials: D
authors.lastname: Turck
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Salomez
authors.forename: Marc
authors.initials: M
authors.lastname: Lemann
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000032:analysis*; D001835:Body Weight; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers