Early endoscopic, laboratory and clinical predictors of poor disease course in paediatric ulcerative colitis.
OBJECTIVE
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.


METHODS
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.


RESULTS
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 score >10; (NPV=91%, positive predictive value=52%; p<0.001), implying that PUCAI >10 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 AUROC<0.6, p>0.05) but baseline PUCAI predicted subsequent acute severe colitis and the need for salvage medical therapy.


CONCLUSIONS
Completeness of the early response appears more important than baseline UC severity for predicting outcome in children, and supports using PUCAI<10 as a feasible treatment goal. Our data suggest that treatment escalation should be considered with a PUCAI value of ≥ 10 at 3 months.
Shaare Zedek Medical Centre, Jerusalem, Israel.
Amir
A
Schechter
The Hospital for Sick Children, Toronto, Ontario, Canada.
Christopher
C
Griffiths
Gastroenterology and Nutrition Department, Division of Pediatrics, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile.
Juan Cristóbal
JC
Gana
Rambam Medical Centre, Haifa, Israel.
Ron
R
Shaoul
Schneider Children's Medical Centre, Petah Tikva, Israel.
Raanan
R
Shamir
Hadassah Medical Centre, Jerusalem, Israel The Hebrew University of Jerusalem, Israel.
Eyal
E
Shteyer
Hadassah Medical Centre, Jerusalem, Israel.
Tali
T
Bdolah-Abram
Shaare Zedek Medical Centre, Jerusalem, Israel.
Oren
O
Ledder
Shaare Zedek Medical Centre, Jerusalem, Israel The Hebrew University of Jerusalem, Israel.
Dan
D
Turner
D002648:Child; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000628:therapy; D003113:Colonoscopy; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
IBD CLINICAL