Predictors of proctocolectomy in children with ulcerative colitis.
OBJECTIVE
Few clinical predictors are associated with definitive proctocolectomy in children with ulcerative colitis (UC). The purpose of the present study was to identify clinical predictors associated with surgery in children with UC using a disease-specific database.


METHODS
Children diagnosed with UC at age <18 years were identified using the Pediatric Inflammatory Bowel Disease Consortium (PediIBDC) database. Demographic and clinical variables from January 1999 to November 2003 were extracted alongside incidence and surgical staging.


RESULTS
Review of the PediIBDC database identified 406 children with UC. Approximately half were girls (51%) with an average age at diagnosis of 10.6 ± 4.4 years in both boys and girls. Average follow-up was 6.8 (±4.0) years. Of the 57 (14%) who underwent surgery, median time to surgery was 3.8 (interquartile range 4.9) years after initial diagnosis. Children presenting with weight loss (hazard ratio [HR] 2.55, 99% confidence interval [CI] 1.21-5.35) or serum albumin <3.5 g/dL (HR 6.05, 99% CI 2.15-17.04) at time of diagnosis and children with a first-degree relative with UC (HR 1.81, 99% CI 1.25-2.61) required earlier surgical intervention. Furthermore, children treated with cyclosporine (HR 6.11, 99% CI 3.90-9.57) or tacrolimus (HR 3.66, 99% CI 1.60-8.39) also required earlier surgical management. Other symptoms, laboratory tests, and medical therapies were not predictive for need of surgery.


CONCLUSIONS
Children with UC presenting with hypoalbuminemia, weight loss, a family history of UC, and those treated with calcineurin inhibitors frequently require restorative proctocolectomy for definitive treatment. Early identification and recognition of these factors should be used to shape treatment goals and initiate multidisciplinary care at the time of diagnosis.
Mattel Children's Hospital, CA, USA.
Lorraine I
LI
Kelley-Quon
Howard C
HC
Jen
David A
DA
Ziring
Neera
N
Gupta
Barbara S
BS
Kirschner
George D
GD
Ferry
Stanley A
SA
Cohen
Harland S
HS
Winter
Melvin B
MB
Heyman
Benjamin D
BD
Gold
Stephen B
SB
Shew
D065095:Calcineurin Inhibitors; D002648:Child; D003093:Colitis, Ulcerative / Q000097:blood / Q000188:drug therapy / Q000235:genetics / Q000601:surgery*; D016572:Cyclosporine / Q000627:therapeutic use; D005190:Family; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D016737:Proctocolectomy, Restorative; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism*; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D015431:Weight Loss
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D012709:Serum Albumin; D016572:Cyclosporine; D016559:Tacrolimus