1. Long-term Outcomes of Paediatric Patients Admitted With Acute Severe Colitis- A Multicentre Study From the Paediatric IBD Porto Group of ESPGHAN.
- Author
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Krauthammer A, Tzivinikos C, Assa A, Miele E, Strisciuglio C, Urlep D, Serban ED, Singh A, Winter HS, Russell RK, Hojsak I, Malham M, Navas-López VM, Croft NM, Lee HM, Ledder O, Shamasneh I, Hussey S, Huynh HQ, Wine E, Shah N, Sladek M, de Meij TG, Romano C, Dipasquale V, Lionetti P, Afzal NA, Aloi M, Lee K, Martín-de-Carpi J, Yerushalmy-Feler A, Subramanian S, Weiss B, and Shouval DS
- Subjects
- Child, Europe epidemiology, Female, Humans, Male, North America epidemiology, Outcome and Process Assessment, Health Care, Retrospective Studies, Severity of Illness Index, Tumor Necrosis Factor Inhibitors therapeutic use, Colectomy adverse effects, Colectomy methods, Colectomy statistics & numerical data, Colitis, Ulcerative diagnosis, Colitis, Ulcerative therapy, Glucocorticoids therapeutic use, Infliximab therapeutic use, Long Term Adverse Effects epidemiology
- Abstract
Background and Aim: Acute severe colitis [ASC] is associated with significant morbidity in paediatric patients with ulcerative colitis [UC]. Most outcome studies in ASC since tumour necrosis factor alpha [TNFα] antagonists became available have focused on the first year after admission. The aim of this study was to characterise the longer-term outcomes of paediatric patients admitted with ASC., Methods: This retrospective study was conducted in 25 centres across Europe and North America. Data on patients with UC aged <18 years, admitted with ASC (defined as paediatric ulcerative colitis activity index [PUCAI] score ≥65) between 2009 and 2011, were collected at discharge and 1, 3 and 5 years after admission. The primary outcome was colectomy-free rates at each time point., Results: Of the 141 patients admitted with ASC, 137 [97.1%] were treated with intravenous corticosteroids. Thirty-one [22.6%] patients were escalated to second-line therapy, mainly to infliximab. Sixteen patients [11.3%] underwent colectomy before discharge. Long-term follow-up showed colectomy-free rates were 71.3%, 66.4% and 63.6% at 1, 3 and 5 years after initial ASC admission, respectively, and were similar across different age groups. Sub-analysis of colectomy rates in patients with new-onset disease [42.5% of the cohort] yielded similar results. In a multivariate analysis, use of oral steroids in the 3 months before admission, erythrocyte sedimentation rate >70 mm/h, and albumin <2.5 g/dL, were significantly associated with 5-year colectomy risk., Conclusions: High colectomy rates were demonstrated in paediatric UC patients admitted with ASC. Additional studies are required to determine whether intensification of anti-TNFα treatment, close therapeutic drug monitoring, and use of new drugs alter this outcome., (Copyright © 2019 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2019
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