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Treffer: Predictors of Complicated Disease Course in Children and Adults With Ulcerative Colitis: A Nationwide Study From the epi-IIRN.

Title:
Predictors of Complicated Disease Course in Children and Adults With Ulcerative Colitis: A Nationwide Study From the epi-IIRN.
Authors:
Atia O; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel., Buchuk R; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel., Lujan R; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel., Greenfeld S; Maccabi Health Services, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Israel., Kariv R; Maccabi Health Services, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Israel., Loewenberg Weisband Y; Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel., Lederman N; Meuhedet Health Services, Tel Aviv, Israel., Matz E; Leumit Health Services, Tel Aviv, Israel., Ledder O; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel., Zittan E; The Abraham and Sonia Rochlin IBD Unit, Institute of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel.; The Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel., Yanai H; Sackler Faculty of Medicine, Tel Aviv University, Israel.; Division of Gastroenterology, Rabin Medical Center, Petah Tikva and the Faculty of Medicine, Tel Aviv University, Israel., Shwartz D; Department of Gastroenterology and Hepatology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer- Sheva, Israel., Freiman M; Faculty of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel., Dotan I; Sackler Faculty of Medicine, Tel Aviv University, Israel.; Division of Gastroenterology, Rabin Medical Center, Petah Tikva and the Faculty of Medicine, Tel Aviv University, Israel., Nevo D; Department of Statistics and Operations Research, Tel Aviv University, Israel., Turner D; Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.
Source:
Inflammatory bowel diseases [Inflamm Bowel Dis] 2025 Mar 03; Vol. 31 (3), pp. 655-664.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Oxford University Press Country of Publication: England NLM ID: 9508162 Publication Model: Print Cited Medium: Internet ISSN: 1536-4844 (Electronic) Linking ISSN: 10780998 NLM ISO Abbreviation: Inflamm Bowel Dis Subsets: MEDLINE
Imprint Name(s):
Publication: 2018- : [Oxford] : Oxford University Press
Original Publication: New York, NY : Raven Press, c1995-
MeSH Terms:
Colitis, Ulcerative*/complications , Colitis, Ulcerative*/pathology , Colitis, Ulcerative*/drug therapy , Colectomy*/statistics & numerical data, Humans ; Male ; Female ; Adult ; Child ; Adolescent ; Severity of Illness Index ; Young Adult ; Middle Aged ; Disease Progression ; Follow-Up Studies ; Prognosis ; C-Reactive Protein/analysis ; Child, Preschool ; Blood Sedimentation ; Biological Products/therapeutic use
Comments:
Comment in: Inflamm Bowel Dis. 2025 Jul 21:izaf069. doi: 10.1093/ibd/izaf069.. (PMID: 40690522)
Grant Information:
Leona M. and Harry B. Helmsley Charitable Trust
Contributed Indexing:
Keywords: colectomy; complicated disease course; epidemiology; outcomes; ulcerative colitis
Local Abstract: [plain-language-summary] Prognostic factors of complicated disease course are vital for clinical decision-making of early escalation to intensive treatment. In this nationwide cohort, one-third of children and one-fifth of adults with UC developed complicated disease course. Disease course was predicted particularly by routinely collected laboratory tests, age, extraintestinal manifestations, and type of induction therapy at diagnosis.
Substance Nomenclature:
9007-41-4 (C-Reactive Protein)
0 (Biological Products)
Entry Date(s):
Date Created: 20240520 Date Completed: 20250422 Latest Revision: 20250721
Update Code:
20250721
DOI:
10.1093/ibd/izae094
PMID:
38768390
Database:
MEDLINE

Weitere Informationen

Background: Data on predictors of complicated ulcerative colitis (UC) course from unselected populations cohorts are scarce. We aimed to utilize a nationwide cohort to explore predictors at diagnosis of disease course in children and adults with UC.
Methods: Data of patients diagnosed with UC since 2005 were retrieved from the nationwide epi-IIRN cohort. Complicated disease course was defined as colectomy, steroid-dependency, or the need for biologic drugs. Hierarchical clustering categorized disease severity at diagnosis based on complete blood count, albumin, C-reactive protein and erythrocyte sedimentation rate (ESR), analyzed together.
Results: A total of 13 471 patients with UC (1427 [11%] pediatric-onset) including 103 212 person-years of follow-up were included. Complicated disease course was recorded in 2829 (21%) patients: 1052 (7.9%) escalated to biologics, 1357 (10%) experienced steroid-dependency, and 420 (3.1%) underwent colectomy. Probabilities of complicated disease course at 1 and 5 years from diagnosis were higher in pediatric-onset (11% and 32%, respectively) than adult-onset disease (4% and 16%; P < .001). In a Cox multivariate model, complicated course was predicted by induction therapy with steroids (hazard ratio [HR], 1.5; 95% CI, 1.2-2.0), extraintestinal manifestations (HR, 1.3; 95% CI, 1.03-1.5) and the disease severity clusters of blood tests (HR, 1.8; 95% CI, 1.01-3.1), while induction therapy with enemas (HR, 0.6; 95% CI, 0.5-0.7) and older age (HR, 0.99; 95% CI, 0.98-0.99) were associated with noncomplicated course.
Conclusion: In this nationwide cohort, the probability of complicated disease course during the first 5 years from diagnosis was 32% in pediatric-onset and 16% in adults with UC and was associated with more severe clusters of routinely collected laboratory tests, younger age at diagnosis, extraintestinal manifestations, and type of induction therapy.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)