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Early endoscopic, laboratory and clinical predictors of poor disease course in paediatric ulcerative colitis
  1. Amir Schechter1,
  2. Christopher Griffiths2,
  3. Juan Cristóbal Gana3,
  4. Ron Shaoul4,
  5. Raanan Shamir5,
  6. Eyal Shteyer6,7,
  7. Tali Bdolah-Abram6,
  8. Oren Ledder1,
  9. Dan Turner1,7
  1. 1Shaare Zedek Medical Centre, Jerusalem, Israel
  2. 2The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Gastroenterology and Nutrition Department, Division of Pediatrics, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
  4. 4Rambam Medical Centre, Haifa, Israel
  5. 5Schneider Children's Medical Centre, Petah Tikva, Israel
  6. 6Hadassah Medical Centre, Jerusalem, Israel
  7. 7The Hebrew University of Jerusalem, Israel
  1. Correspondence to Dr D Turner, Departments of Paediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Centre, The Hebrew University, POB 3235, Jerusalem 91031, Israel; turnerd{at}


Objective Data to support treatment algorithms in ambulatory paediatric UC are scarce. We aimed to explore the 1 year outcome in an inception cohort of paediatric UC patients and to identify early predictors of good outcome that might serve as short term treatment targets.

Design A chart review of 115 children with new onset UC was performed (age 11±4.1 years; 58 (50%) males; 86 (75%) extensive colitis; 70 (61%) moderate–severe disease; 63 (55%) received steroids at baseline). We assessed the Paediatric Ulcerative Colitis Activity Index (PUCAI) and laboratory variables at the time of diagnosis and at 3 months, and endoscopy at diagnosis.

Results The 3 month PUCAI was the strongest predictor of 1 year sustained steroid free remission (SSFR) (area under the receiver operating characteristic curve (AUROC)=0.7 (95% CI 0.6 to 0.8) and colectomy by 2 years (AUROC=0.75 (0.6 to 0.89)). SSFR was achieved in 9/54 (17%) children who had active disease (PUCAI ≥10) at 3 months (negative predictive value (NPV)=83%) and by 4/46 (8.6%) of those with a PUCAI score >10; (NPV=91%, positive predictive value=52%; p<0.001), implying that PUCAI >10 at 3 months has a probability of 9% for achieving SSFR versus 48% with a PUCAI value of ≤10. None of the variables at baseline was predictive of SSFR or colectomy (endoscopic severity, disease extent, age, PUCAI or C reactive protein/erythrocyte sedimentation rate/albumin/haemoglobin; all AUROC<0.6, p>0.05) but baseline PUCAI predicted subsequent acute severe colitis and the need for salvage medical therapy.

Conclusions Completeness of the early response appears more important than baseline UC severity for predicting outcome in children, and supports using PUCAI<10 as a feasible treatment goal. Our data suggest that treatment escalation should be considered with a PUCAI value of ≥10 at 3 months.


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