1. Predicting Outcomes in Pediatric Ulcerative Colitis for Management Optimization: Systematic Review and Consensus Statements From the Pediatric Inflammatory Bowel Disease-Ahead Program
- Author
-
Thomas D. Walters, Marina Aloi, Jiri Bronsky, Esther Orlanski Meyer, M Aardoom, Lissy de Ridder, Frank M. Ruemmele, Marina Orsi, Richard K Russell, Seamus Hussey, Javier Martín de Carpi, Amanda Ricciuto, Anne M. Griffiths, Peter Lewindon, Gábor Veres, Dan Turner, David C. Wilson, Nicholas Carman, Thomas Kaiser, Daniel Navon, Marla Dubinsky, Jan Däbritz, Víctor Manuel Navas-López, and Pediatrics
- Subjects
0301 basic medicine ,Male ,medicine.medical_treatment ,Disease ,0302 clinical medicine ,Outcome Assessment, Health Care ,Medicine ,Child ,acute severe colitis ,Colectomy ,Cancer ,pediatric ulcerative colitis ,Thiopurine methyltransferase ,biology ,Gastroenterology ,Prognosis ,Ulcerative colitis ,Pediatric Ulcerative Colitis ,Prediction ,Child, Preschool ,030211 gastroenterology & hepatology ,Female ,Acute Severe Colitis ,Mortality ,medicine.medical_specialty ,Consensus ,Adolescent ,Pediatric ulcerative colitis ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,Predictive Value of Tests ,Internal medicine ,cancer ,Humans ,Severe colitis ,Hepatology ,Prognostic Factors ,business.industry ,colectomy ,mortality ,prediction ,prognostic factors ,Infant, Newborn ,Infant ,medicine.disease ,030104 developmental biology ,biology.protein ,Colitis, Ulcerative ,Personalized medicine ,business - Abstract
BACKGROUND & AIMS: A better understanding of prognostic factors in ulcerative colitis (UC) could improve patient management and reduce complications. We aimed to identify evidence-based predictors for outcomes in pediatric UC, which may be used to optimize treatment algorithms. METHODS: Potential outcomes worthy of prediction in UC were determined by surveying 202 experts in pediatric UC. A systematic review of the literature, with selected meta-analysis, was performed to identify studies that investigated predictors for these outcomes. Multiple national and international meetings were held to reach consensus on evidence-based statements. RESULTS: Consensus was reached on 31 statements regarding predictors of colectomy, acute severe colitis (ASC), chronically active pediatric UC, cancer and mortality. At diagnosis, disease extent (6 studies, N = 627; P = .035), Pediatric Ulcerative Colitis Activity Index score (4 studies, n = 318; P < .001), hemoglobin, hematocrit, and albumin may predict colectomy. In addition, family history of UC (2 studies, n = 557; P = .0004), extraintestinal manifestations (4 studies, n = 526; P = .048), and disease extension over time may predict colectomy, whereas primary sclerosing cholangitis (PSC) may be protective. Acute severe colitis may be predicted by disease severity at onset and hypoalbuminemia. Higher Pediatric Ulcerative Colitis Activity Index score and C-reactive protein on days 3 and 5 of hospital admission predict failure of intravenous steroids. Risk factors for malignancy included concomitant diagnosis of primary sclerosing cholangitis, longstanding colitis (>10 years), male sex, and younger age at diagnosis. CONCLUSIONS: These evidence-based consensus statements offer predictions to be considered for a personalized medicine approach in treating pediatric UC.
- Published
- 2020