Predicting complications in pediatric Crohn's disease patients followed in CEDATA-GPGE registry

Abstract

BackgroundComplications of Crohn's disease (CD) often impair patients' quality of life. It is necessary to predict and prevent these complications (surgery, stricturing [B2]/penetrating [B3] disease behavior, perianal disease, growth retardation and hospitalization). Our study investigated previously suggested and additional predictors by analyzing data of the CEDATA-GPGE registry.MethodsPediatric patients (< 18 years) diagnosed with CD with follow up data in the registry were included in the study. Potential risk factors for the selected complications were evaluated by performing Kaplan-Meier survival curves and cox regression models.ResultsFor the complication surgery, the potential risk factors older age, B3 disease, severe perianal disease and initial therapy with corticosteroids at the time of diagnosis were identified. Older age, initial therapy with corticosteroids, low weight-for-age, anemia and emesis predict B2 disease. Low weight-for-age and severe perianal disease were risk factors for B3 disease. Low weight-for-age, growth retardation, older age, nutritional therapy, and extraintestinal manifestations (EIM) of the skin were identified as risk factors for growth retardation during the disease course. High disease activity and treatment with biologicals were predictors for hospitalization. As risk factors for perianal disease, the factors male sex, corticosteroids, B3 disease, a positive family history and EIM of liver and skin were identified.ConclusionWe confirmed previously suggested predictors of CD course and identified new ones in one of the largest registries of pediatric CD patients. This may help to better stratify patients’ according to their individual risk profile and choose appropriate treatment strategies.

Grundlagen der Diagnose und Therapie chronisch entzündlicher Darmerkrankungen

“…Daher bedarf es einer individuellen Begleitung. Ein kleineres Kind hat andere Ängste und Bedürfnisse als ein pubertierender Teenager, der Probleme hat, die Erkrankung zu akzeptieren mit all ihren Einschränkungen: „Jugendliche weisen gemäß verschiedenen Studien eine schlechtere Adhärenz auf als jüngere Kinder“ 1 2 . Auch können laut Dr. med.…”

Identifying predictors of clinical outcomes using the projection-predictive feature selection—a proof of concept on the example of Crohn’s disease

“…Therefore, several clinical disease activity indices (DAIs) were developed using noninvasive clinical and standard laboratory parameters for monitoring the severity of CD-associated intestinal inflammation in clinical practice. For example, the Pediatric Crohn's Disease Activity Index (PCDAI) ( 4) is determined regularly in the CEDATA-GPGE registry including data of 6,233 pediatric patients with inflammatory bowel disease (IBD) in 2022 (5). However, the PCDAI, developed in 1991, has not been validated against established endoscopic disease activity scores and includes subjective variables which may potentially compromise its predictive performance.…”

Clusters of Disease Activity and Early Risk Factors of Clinical Course of Pediatric Crohn’s Disease

“…Although several studies have attempted to pinpoint prognostic factors of disease course in both children and adults, in real-life practice each patient's disease course remains somewhat unpredictable. [6][7][8] This can make it challenging to decide on a tailored treatment strategy early at the diagnosis. In 2021, Wintjens et al 9 reported data from a cohort of 432 adult patients with CD, divided into 6 clusters of activity in a 10-year follow-up.…”