Predicting Outcomes in Pediatric Ulcerative Colitis for Management Optimization: Systematic Review and Consensus Statements From the Pediatric Inflammatory Bowel Disease–Ahead Program

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 evidencebased 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 ¼ 627; P ¼ .035), Pediatric Ulcerative Colitis Activity Index score (4 studies, n ¼ 318; P < .001), hemoglobin, hematocrit, and albumin may predict colectomy. In addition, family history of UC (2 studies, n ¼ 557; P ¼ .0004), extraintestinal manifestations (4 studies, n ¼ 526; P ¼ .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.

Serum Albumin Before CRRT Was Associated With the 28- and 90-Day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy

“…ALB is one of the most critical proteins in the human plasma because it may maintain plasma colloid osmotic pressure, engage in material transport in blood circulation, and facilitate communication among the intracellular fluid, extracellular fluid, and tissue fluid ( 9 ). Hypoalbuminemia is widespread in patients with critical illnesses, and it is widely recognized as being linked to patient deterioration and higher death ( 10 , 11 ). The incidence of hypoproteinemia in hospitalized patients is ~21% ( 12 ), but its incidence in acute illness is more than 50% ( 13 ).…”

Increasing rate of a positive family history of inflammatory bowel disease (IBD) in pediatric IBD patients

“…A number of them have linked a positive family history to younger age at diagnosis of IBD [11][12][13]. Others have further suggested a positive relation between family history of IBD and a more aggressive disease [14][15][16], however, these results were challenged in other studies [17].…”

Endoscopic and Histologic Predictors of Outcomes in Pediatric Ulcerative Colitis—Caveat Emptor

“…There are even less histopathologic data than endoscopic data on predictors of future clinical outcomes in pediatrics. Histology did not feature significantly in the recent PIBD Ahead review of prognostic indicators, due to limited data availability ( 19 ). In adults, a higher baseline GS is significantly associated with risk of later clinical relapse ( 60 ).…”

“…Early predictors for those most likely to have worst outcomes would help guide treatment and tailor therapy to the individual patient ( 18 ). The PIBD Ahead Programme recently published an extensive appraisal and statement of current outcome predictors in UC ( 19 ). Among the outcomes most concerning to clinicians in a survey across 33 countries were risk of relapse, developing acute severe colitis and colectomy.…”