Arie Levine1, Neil Chanchlani2, Seamus Hussey3, Tomer Ziv-Baran4, Johanna C Escher5, Jorge Amil Dias6, Gabor Veres7, Sibylle Koletzko8, Dan Turner9, Kaija-Leena Kolho10, Anders Paerregaard11, Annamaria Staiano12, Paolo Lionetti13, Federica Nuti14,15, Malgorata Sladek16, Ron Shaoul17, Isabella Lazowska-Prezeorek18, Javier Martin de Carpi19, Rotem Sigall Boneh1, Tamar Pfeffer Gik1, Noa Cohen-Dolev1, Richard K Russell20. 1. Paediatric Gastroenterology and Nutrition Unit, Tel Aviv University, Edith Wolfson Medical Center, Holon, Israel. 2. Exeter IBD Pharmacogenetics, RILD building, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. 3. National Children's Research Centre, Crumlin; Department of Paediatrics, UCD and RCSI, Dublin, Ireland. 4. School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel. 5. Erasmus MC-Sophia Children's Hospital, Pediatric Gastroenterology, Rotterdam, Netherlands. 6. Pediatric Gastroenterology Unit, Centro Hospitalar de São João, Porto, Portugal. 7. Pediatric Institute, University of Debrecen, Hungary. 8. Ludwig Maximilians-Universität München, Dr. von Hauner Children's Hospital, Munich, Germany. 9. Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel. 10. University of Tampere, Tampere, Finland and Children's Hospital, Helsinki, Finland. 11. Department of Paediatrics 460, Hvidovre University Hospital, Denmark. 12. Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 13. University of Florence-Meyer Hospital, Florence, Italy. 14. Intermediate Pediatric Care Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 15. Pediatric Gastroenterology and Hepatology Unit, Sapienza University Rome, Italy. 16. Jagiellonian University Medical College, Krakow, Poland. 17. Rambam Medical Center, Haifa, Israel. 18. Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Poland. 19. Department of Pediatric Gastroenterology, Hepatology and Nutritiom, Hospital Sant Joan de Déu, Barcelona, Spain. 20. Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK.
Abstract
INTRODUCTION: The ability to predict risk for poor outcomes in Crohn's disease [CD] would enable early treatment intensification. We aimed to identify children with CD with complications at baseline and throughout the study period who are at risk for surgery 2 years from diagnosis. METHODS: Newly diagnosed children with CD were enrolled into a prospective, multicentre inception cohort. Disease characteristics and serological markers were obtained at baseline and week 12 thereafter. Outcome data including disease activity, therapies, complications and need for surgery were collected until the end of 104 weeks. A chi-square automatic interaction detection [CHAID] algorithm was used to develop a prediction model for early surgery. RESULTS: Of 285 children enrolled, 31 [10.9%] required surgery within 2 years. Multivariate analysis identified stricturing disease at baseline (odds ratio [OR] 5.26, 95% confidence interval [CI] 2.02-13.67 [p = 0.001]), and Paediatric Crohn's Disease Activity Index [PCDAI] >10 at week 12 (OR 1.06, 95% CI 1.02-1.10 [p = 0.005]) as key predictors for early surgery. CHAID demonstrated that absence of strictures at diagnosis [7.6%], corticosteroid-free remission at week 12 [4.1%] and early immunomodulator therapy [0.8%] were associated with the lowest risk of surgery, while stricturing disease at diagnosis [27.1%, p < 0.001] or elevated PCDAI at week 12 [16.7%, p = 0.014] had an increased risk of surgery at follow-up. Anti-OmpC status further stratified high-risk patients. DISCUSSION: A risk algorithm using clinical and serological variables at diagnosis and week 12 can categorize patients into high- and low-risk groups from diagnosis.
INTRODUCTION: The ability to predict risk for poor outcomes in Crohn's disease [CD] would enable early treatment intensification. We aimed to identify children with CD with complications at baseline and throughout the study period who are at risk for surgery 2 years from diagnosis. METHODS: Newly diagnosed children with CD were enrolled into a prospective, multicentre inception cohort. Disease characteristics and serological markers were obtained at baseline and week 12 thereafter. Outcome data including disease activity, therapies, complications and need for surgery were collected until the end of 104 weeks. A chi-square automatic interaction detection [CHAID] algorithm was used to develop a prediction model for early surgery. RESULTS: Of 285 children enrolled, 31 [10.9%] required surgery within 2 years. Multivariate analysis identified stricturing disease at baseline (odds ratio [OR] 5.26, 95% confidence interval [CI] 2.02-13.67 [p = 0.001]), and Paediatric Crohn's Disease Activity Index [PCDAI] >10 at week 12 (OR 1.06, 95% CI 1.02-1.10 [p = 0.005]) as key predictors for early surgery. CHAID demonstrated that absence of strictures at diagnosis [7.6%], corticosteroid-free remission at week 12 [4.1%] and early immunomodulator therapy [0.8%] were associated with the lowest risk of surgery, while stricturing disease at diagnosis [27.1%, p < 0.001] or elevated PCDAI at week 12 [16.7%, p = 0.014] had an increased risk of surgery at follow-up. Anti-OmpC status further stratified high-risk patients. DISCUSSION: A risk algorithm using clinical and serological variables at diagnosis and week 12 can categorize patients into high- and low-risk groups from diagnosis.
Authors: Martine A Aardoom; Polychronis Kemos; Irma Tindemans; Marina Aloi; Sibylle Koletzko; Arie Levine; Dan Turner; Gigi Veereman; Mattias Neyt; Richard K Russell; Thomas D Walters; Frank M Ruemmele; Janneke N Samsom; Nicholas M Croft; Lissy de Ridder Journal: BMJ Open Date: 2020-07-01 Impact factor: 2.692
Authors: Rachel E Harris; Marina Aloi; Lissy de Ridder; Nicholas M Croft; Sibylle Koletzko; Arie Levine; Dan Turner; Gigi Veereman; Mattias Neyt; Laetitia Bigot; Frank M Ruemmele; Richard K Russell Journal: BMJ Open Date: 2020-07-01 Impact factor: 2.692
Authors: Maria M E Jongsma; Martine A Aardoom; Martinus A Cozijnsen; Merel van Pieterson; Tim de Meij; Michael Groeneweg; Obbe F Norbruis; Victorien M Wolters; Herbert M van Wering; Iva Hojsak; Kaija-Leena Kolho; Thalia Hummel; Janneke Stapelbroek; Cathelijne van der Feen; Patrick F van Rheenen; Michiel P van Wijk; Sarah T A Teklenburg-Roord; Marco W J Schreurs; Dimitris Rizopoulos; Michail Doukas; Johanna C Escher; Janneke N Samsom; Lissy de Ridder Journal: Gut Date: 2020-12-31 Impact factor: 23.059