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Predictors for Pouchitis After Ileal Pouch-Anal Anastomosis for Pediatric-Onset Ulcerative Colitis
- Source :
- Journal of Surgical Research. 238:72-78
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Background The predictive factors for the development of pouchitis after ileal pouch-anal anastomosis (IPAA) in pediatric-onset ulcerative colitis (UC) have not been well investigated. The present study aimed to determine the predictive factors for the development of pouchitis after IPAA in the pediatric UC population. Methods The data from 54 patients with pediatric-onset UC who underwent IPAA in Mie University Hospital between 2000 and 2017 were retrospectively reviewed. A modified pouchitis disease activity index of ≥5 was defined as pouchitis. Potential preoperative, intraoperative, and postoperative predictors for pouchitis including various demographic and clinical variables were analyzed using Cox regression analysis, Students’ t-tests, Mann–Whitney U tests, and Kaplan–Meier curves. The optimal cutoff value for continuous variables was determined using the receiver operating characteristic curve analysis. Results Pouchitis was identified in 17 (31.5%) patients within 5 y of follow-up. In multivariable analysis, the independent predictors for pouchitis were preoperative cumulative steroid dose of >10,000 mg (P = 0.0056) and >65% neutrophils just before IPAA (P = 0.032). Multivariate analysis revealed that the independent predictors of pouchitis were a total steroid dose of >10,000 mg (P = 0.0002) and a neutrophil percentage of >65% (P = 0.0078). No patient for whom both of these independent predictors were negative developed pouchitis, whereas >40% of patients who had one or both predictors developed pouchitis. Conclusions In pediatric patients with UC, the predictive factors for pouchitis development are a greater cumulative total dose of steroids and a greater percentage of neutrophils before IPAA.
- Subjects :
- Male
medicine.medical_specialty
Multivariate analysis
Adolescent
Neutrophils
Population
Pouchitis
Anastomosis
Severity of Illness Index
Gastroenterology
Leukocyte Count
Young Adult
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
Risk factor
Child
Perioperative Period
education
Glucocorticoids
Retrospective Studies
education.field_of_study
Dose-Response Relationship, Drug
Receiver operating characteristic
Proportional hazards model
business.industry
Proctocolectomy, Restorative
medicine.disease
Ulcerative colitis
ROC Curve
Child, Preschool
030220 oncology & carcinogenesis
Multivariate Analysis
Colitis, Ulcerative
Female
030211 gastroenterology & hepatology
Surgery
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 00224804
- Volume :
- 238
- Database :
- OpenAIRE
- Journal :
- Journal of Surgical Research
- Accession number :
- edsair.doi.dedup.....d321c05b89da24dba36316c4a75ed361