BACKGROUND & AIMS: A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management. METHODS: A survey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence. RESULTS: Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density. CONCLUSIONS: These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk.

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 Children's Hospital of Eastern Ontario 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

Erasmus Medical Center Sophia Children's Hospital Rotterdam the Netherlands

IBD Centre SickKids Hospital University of Toronto Toronto Canada

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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