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.
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: Lorraine I Kelley-Quon; Howard C Jen; David A Ziring; Neera Gupta; Barbara S Kirschner; George D Ferry; Stanley A Cohen; Harland S Winter; Melvin B Heyman; Benjamin D Gold; Stephen B Shew Journal: J Pediatr Gastroenterol Nutr Date: 2012-11 Impact factor: 2.839
Authors: Jarod P McAteer; Cindy Larison; Ghassan T Wahbeh; Matthew P Kronman; Adam B Goldin Journal: Pediatr Surg Int Date: 2013-04-10 Impact factor: 1.827
Authors: Jeffrey S Hyams; Michael Brimacombe; Yael Haberman; Thomas Walters; Greg Gibson; Angela Mo; David Mack; Anne Griffiths; Brendan Boyle; Neal LeLeiko; James Markowitz; Joel Rosh; Ashish Patel; Sapana Shah; Robert Baldassano; Marian Pfefferkorn; Cary Sauer; Joelynn Dailey; Suresh Venkateswaran; Subra Kugathasan; Lee A Denson Journal: Inflamm Bowel Dis Date: 2022-02-01 Impact factor: 5.325
Authors: Jeffrey S Hyams; Sonia Davis; David R Mack; Brendan Boyle; Anne M Griffiths; Neal S LeLeiko; Cary G Sauer; David J Keljo; James Markowitz; Susan S Baker; Joel Rosh; Robert N Baldassano; Ashish Patel; Marian Pfefferkorn; Anthony Otley; Melvin Heyman; Joshua Noe; Maria Oliva-Hemker; Paul Rufo; Jennifer Strople; David Ziring; Stephen L Guthery; Boris Sudel; Keith Benkov; Prateek Wali; Dedrick Moulton; Jonathan Evans; Michael D Kappelman; Alison Marquis; Francisco A Sylvester; Margaret H Collins; Suresh Venkateswaran; Marla Dubinsky; Vin Tangpricha; Krista L Spada; Ashley Britt; Bradley Saul; Nathan Gotman; Jessie Wang; Jose Serrano; Subra Kugathasan; Thomas Walters; Lee A Denson Journal: Lancet Gastroenterol Hepatol Date: 2017-09-20
Authors: Yael Haberman; Rebekah Karns; Phillip J Dexheimer; Melanie Schirmer; Judith Somekh; Ingrid Jurickova; Tzipi Braun; Elizabeth Novak; Laura Bauman; Margaret H Collins; Angela Mo; Michael J Rosen; Erin Bonkowski; Nathan Gotman; Alison Marquis; Mason Nistel; Paul A Rufo; Susan S Baker; Cary G Sauer; James Markowitz; Marian D Pfefferkorn; Joel R Rosh; Brendan M Boyle; David R Mack; Robert N Baldassano; Sapana Shah; Neal S Leleiko; Melvin B Heyman; Anne M Grifiths; Ashish S Patel; Joshua D Noe; Bruce J Aronow; Subra Kugathasan; Thomas D Walters; Greg Gibson; Sonia Davis Thomas; Kevin Mollen; Shai Shen-Orr; Curtis Huttenhower; Ramnik J Xavier; Jeffrey S Hyams; Lee A Denson Journal: Nat Commun Date: 2019-01-03 Impact factor: 14.919