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OP014. Early endoscopic, laboratory and clinical predictors of poor disease course in pediatric ulcerative colitis (UC)

D. Turner1, C. Griffiths2, J.C. Gana3, R. Shaoul4, R. Shamir5, E. Shteyer6, T. Bdolah-Abram6, A. Schechter1, 1Shaare Zedek Medical Centre, Pediatric Gastroenterology and Nutrition, Jerusalem, Israel, 2The Hospital for Sick Children, Department of Paediatrics, Toronto, ON, Canada, 3Pontificia Universidad Católica de Chile, Department of Pediatrics, Chile, Chile, 4Rambam Medical Cenetr, Pediatric GI, Haifa, Israel, 5Schneider Children's Medical Center of Israel, Institute of Gastroenterology, Petach Tikva, Israel, 6Hadassah Medical Center, Pediatric GI, Jerusalem, Israel

Background

Current data regarding predictors for disease outcomes 1-year after diagnosis in pediatric UC are scarce and conflicting. We aimed to explore 1-year outcome in an inception cohort of pediatric UC and to identify early endoscopic, clinical and demographic predictors for selecting those who require more aggressive therapy.

Methods

Chart review of 115 children with new onset UC was performed in 7 pediatric IBD centers (age 11±4.1 years (range 2–18), 58 (50%) males, 86 (75%) extensive colitis, 70 (61%) moderate–severe disease; 63 (55%) received steroids at baseline and 21 (18%) thiopurines/anti-TNF at 3 months). We assessed the PUCAI and laboratory variables at the time of diagnosis and 3-months, and endoscopy at diagnosis.

Results

The 3-month PUCAI was the strongest predictor for 1-year sustained steroid-free remission (SSFR) (AUROC 0.7 (95% CI 0.6–0.8). Only 9/54 children who had active disease (PUCAI ≥10) at 3 months, had SSFR (NPV=83%), vs 31/59 children who had PUCAI <10 (PPV=53%);P < 0.001). Only 2/21 children in moderate/severe state (PUCAI ≥35) at 3 months achieved SSFR. The 3-month PUCAI also moderately predicted the need for salvage medical therapy or colectomy (AUROC=0.66 (95% CI 0.55–0.78;P = 0.005). None of the variables at baseline were predictive (endoscopic severity, disease extent, age, PUCAI and CRP/ESR/albumin/hemoglobin; all AUROC < 0.6, P > 0.05). In a multivariable analysis, the 3-month PUCAI was a stronger predictor (P = 0.005) than the other parameters.

Conclusion

Completeness of early response appears more important than baseline UC severity in predicting 1 year outcome in children and supports using complete remission (PUCAI <10) as a treatment goal. Our data suggest that treatment escalation should be considered with PUCAI ≥10 at 3-months and is mandated with PUCAI ≥35.