Naslov
Long-term Outcomes of Paediatric Patients Admitted With Acute Severe Colitis— A Multicentre Study From the Paediatric IBD Porto Group of ESPGHAN

Autori
Krauthammer, Alex ; Tzivinikos, Christos ; Assa, Amit ; Miele, Erasmo ; Strisciuglio, Caterina ; Urlep, Darja ; Serban, Elena Daniela ; Singh, Avantika ; Winter, Harland S ; Russell, Richard K ; Hojsak, Iva ; Malham, Mikkel ; Navas-López, Víctor Manuel ; Croft, Nicholas M ; Lee, Huey Miin ; Ledder, Oren ; Shamasneh, Ibrahim ; Hussey, Seamus ; Huynh, Hien Q ; Wine, Eytan ; Shah, Neil ; Sladek, Margaret ; de Meij, Tim G ; Romano, Claudio ; Dipasquale, Valeria ; Lionetti, Paolo ; Afzal, Nadeem A ; Aloi, Marina ; Lee, Kwangyang ; Martín-de-Carpi, Javier ; Yerushalmy-Feler, Anat ; Subramanian, Sreedhar ; Weiss, Batia ; Shouval, Dror S

Izvornik
Journal of Crohn's and Colitis (1873-9946) 13 (2019), 12; 1518-1526

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
UC ; acute severe colitis ; anti-TNFa ; biologics ; colectomy

Sažetak
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.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA