Clinical variables as prognostic tools in pediatric‐onset ulcerative colitis: A retrospective cohort study

• Published in: Inflammatory bowel diseases 2011-01, Vol.17 (1), p.15-21
• Main Authors: Moore, Jill C., Thompson, Kimberly, LaFleur, Bonnie, Book, Linda S., Jackson, W. Daniel, O'Gorman, Molly A., Black, Richard E., Downey, Earl, Johnson, Dale G., Matlak, Michael E., Meyers, Rebecka L., Scaife, Eric, Guthery, Stephen L.
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Cohort Studies; Colectomy; Colitis, Ulcerative - pathology; Colitis, Ulcerative - surgery; Data processing; Hematocrit; Humans; Inflammatory bowel diseases; Intestine; Leukocytes; pediatric onset; Pediatrics; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Ulcerative colitis
• ISSN: 1078-0998; 1536-4844; 1536-4844
• DOI: 10.1002/ibd.21393

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. (Inflamm Bowel Dis 2011;)