BACKGROUND & AIMS: A better understanding of prognostic factors in ulcerative colitis (UC) could improve patient management and reduce complications. We aimed to identify evidence-based predictors for outcomes in pediatric UC, which may be used to optimize treatment algorithms. METHODS: Potential outcomes worthy of prediction in UC were determined by surveying 202 experts in pediatric UC. A systematic review of the literature, with selected meta-analysis, was performed to identify studies that investigated predictors for these outcomes. Multiple national and international meetings were held to reach consensus on evidence-based statements. RESULTS: Consensus was reached on 31 statements regarding predictors of colectomy, acute severe colitis (ASC), chronically active pediatric UC, cancer and mortality. At diagnosis, disease extent (6 studies, N = 627; P = .035), Pediatric Ulcerative Colitis Activity Index score (4 studies, n = 318; P < .001), hemoglobin, hematocrit, and albumin may predict colectomy. In addition, family history of UC (2 studies, n = 557; P = .0004), extraintestinal manifestations (4 studies, n = 526; P = .048), and disease extension over time may predict colectomy, whereas primary sclerosing cholangitis (PSC) may be protective. Acute severe colitis may be predicted by disease severity at onset and hypoalbuminemia. Higher Pediatric Ulcerative Colitis Activity Index score and C-reactive protein on days 3 and 5 of hospital admission predict failure of intravenous steroids. Risk factors for malignancy included concomitant diagnosis of primary sclerosing cholangitis, longstanding colitis (>10 years), male sex, and younger age at diagnosis. CONCLUSIONS: These evidence-based consensus statements offer predictions to be considered for a personalized medicine approach in treating pediatric UC.

Child Life and Health University of Edinburgh Paediatric Gastroenterology and Nutrition Royal Hospital for Sick Children Edinburgh Scotland United Kingdom

Children's Hospital of Eastern Ontario IBD Centre University of Ottawa Ottawa Canada

Department of General Pediatrics University Hospital Münster Germany

Department of Paediatric Gastroenterology Royal Hospital for Sick Children Edinburgh Scotland United Kingdom

Department of Pediatric Gastroenterology Hepatology and Nutrition Hospital Sant Joan de Déu Barcelona Spain

Department of Pediatrics University Hospital Motol Prague Czech Republic

Division of Gastroenterology Hepatology and Nutrition the Hospital for Sick Children Toronto Canada

Erasmus Medical Center Sophia Children's Hospital Rotterdam the Netherlands

Institute of Pediatric Gastroenterology Shaare Zedek Medical Center the Hebrew University of Jerusalem Israel

National Children's Research Centre Royal College of Surgeons of Ireland and University College Dublin Dublin Ireland

Pediatric Gastroenterology and Nutrition Mount Sinai Kravis Children's Hospital; Susan and Leonard Feinstein IBD Clinical Center Icahn School of Medicine Mount Sinai New York

Pediatric Gastroenterology and Nutrition Unit Hospital Regional Universitario de Málaga Spain

Pediatric Gastroenterology Hepatology and Transplant Unit Hospital Italiano de Buenos Aires Argentina

Pediatric Gastroenterology Unit Sapienza University of Rome Umberto 1 Hospital Rome Italy

Pediatric Institute Clinic University of Debrecen Hungary

Université Paris Descartes Sorbonne Paris Cité; Assistance Publique Hôpitaux de Paris Hôpital Necker Enfants Malades Service de Gastroentérologie Pédiatrique; Institute IMAGINE Inserm U1163 Paris France

University Medical Center Rostock Department of Pediatrics Rostock Germany; Queen Mary University of London The Barts and the London School of Medicine and Dentistry Blizard Institute Center for Immunobiology London United Kingdom

University of Queensland Brisbane Australia

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