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P302 Predictors of outcome in children with Crohn’s disease

M. T. Fioretti*1, C. Strisciuglio2, M. Martinelli1, P. Dolce3, G. Vallone4, A. Staiano1, E. Miele1

1University of Naples Federico II, Department of Translational Medical Science, Section of Pediatrics, Naples, Italy, 2University of Campania ‘Luigi Vanvitelli’, Department of Woman, Child and General and Specialistic Surgery, Naples, Italy, 3University of Naples Federico II, Public of Health Department, Naples, Italy, 4University of Naples Federico II, Department of Radiology Section of Pediatric Diagnostics, Naples, Italy

Background

Data regarding the incidence and the risk factors either for biologic therapy or for surgery in children with Crohn's disease (CD) are still lacking. The aims of this study were to determine the cumulative incidence of need for biologics and for surgery and to identify associated risk factors in a cohort of children with CD.

Methods

We conducted a retrospective chart review of 56 children diagnosed with CD from January 2013 through June 2017 with at least 12 months follow-up. Age at onset; gender; family history; anthropometric data; clinical, laboratory, endoscopic, and histological findings at diagnosis, timing of therapeutic regimens, and small bowel US were thoroughly investigated. Data regarding disease localisation according to Paris classification and disease activity indexes were also collected. The primary outcome was defined as need for biologic therapy and for intestinal surgery. Statistical significance was predetermined as p < 0.05. Percentages were rounded to the nearest whole numbers.

Results

The 56 enrolled patients [M/F: 31/25; median age: 12.8 years (range 6.7–16.8)] were divided into two groups: Group A, represented by 41 (73%) patients who did not receive biological treatment and/or surgery; Group B, represented by the remaining 15 (27%) patients subjected to biological treatment and/or surgery. Univariate Cox models showed that family history (hazard ratio [HR] 3.02, p = 0.04), C-reactive protein (CRP) (HR 1,016, p <0.001) and terminal ileal thickening (HR 1.14, p = 0.02) were associated with increased risk for intestinal surgery and/or use of biologics. Age, gender, anthropometrics, disease activity, disease behaviour and location, and extraintestinal manifestation were not associated with the need for more intensive therapy. Kaplan–Meier survival estimates of the cumulative incidence of surgery and biological therapy were 36.6% (95% CI = 17.2%–49.9%) at 5 years from the diagnosis of MC (Figure 1).

Conclusion

In children with CD, our preliminary data suggest that family history, CRP, and terminal ileal thickening evaluated by US at diagnosis are independent risk factors for biologic therapy and bowel surgery. In addition, in contrast with previous studies, we found a low cumulative rate of bowel surgery with a similar use of biologic therapy.