title: Risk of Colectomy in Patients With Pediatric-onset Ulcerative Colitis.
abstract: Data describing the incidence and risk factors for colectomy in pediatric ulcerative colitis (UC) is inconsistent. Our aim was to describe the colectomy rate and to identify risk factors associated with colectomy in a large cohort of children with UC with long-term follow-up.
  
  
  
  We performed a retrospective chart review of pediatric UC cases that were diagnosed at Schneider Children's Medical Center of Israel between 1981 and 2013. Potential predictors for colectomy including age at diagnosis, sex, disease extent, severity indices, and different therapeutic regimens during disease course were assessed.
  
  
  
  Of 188 patients with pediatric onset UC, 34 (18%) underwent colectomy. Median follow-up was 6.9 years (range, 1-30). Kaplan-Meier survival estimates of the cumulative probability for colectomy were 4% at 1 year and 17% at 10 years from diagnosis. Multivariate Cox models showed that male sex (hazard ratio 4.2, P = 0.001) and severe disease at diagnosis reflected by Pediatric Ulcerative Colitis Activity Index score ≥65 (hazard ratio 8.9, P < 0.001) were associated with increased risk for colectomy. Age, disease extent, ethnicity, family history of inflammatory bowel disease, early introduction of immunomodulators, or treatment with antitumor necrosis factor α agent did not affect the risk of colectomy.
  
  
  
  Male sex and higher Pediatric Ulcerative Colitis Activity Index score at diagnosis are independent risk factors for colectomy.
authors.affiliation: Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva Sackler Faculty of Medicine, Tel-Aviv University Department of Gastroenterology, Sheba Medical Center-Tel Hashomer, Tel Aviv Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Firas
authors.initials: F
authors.lastname: Rinawi
authors.forename: Amit
authors.initials: A
authors.lastname: Assa
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.forename: Yael
authors.initials: Y
authors.lastname: Mozer-Glassberg
authors.forename: Vered
authors.initials: V
authors.lastname: Nachmias-Friedler
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.forename: Yoram
authors.initials: Y
authors.lastname: Rosenbach
authors.forename: Ari
authors.initials: A
authors.lastname: Silbermintz
authors.forename: Noam
authors.initials: N
authors.lastname: Zevit
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
mesh_terms: D000293:Adolescent; D002648:Child; D003082:Colectomy / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index