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Dig Dis Sci. 2019 Feb 7. doi: 10.1007/s10620-019-05486-w. [Epub ahead of print]

Early Response to Corticosteroid and Baseline C-Reactive Protein Predicts Outcomes in Children with Moderate to Severe Ulcerative Colitis.

Author information

1
Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia.
2
Gastroenterology Department, Lady Cilento Hospital, Brisbane, 4101, Australia.
3
Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia. zubin.grover@health.wa.gov.au.

Abstract

BACKGROUND:

Initial response to corticosteroids (CS) is recognized as a strong predictor of outcomes in ulcerative colitis (UC).

AIM:

To compare outcomes of early poor responders (PR) versus good responders (GR) to initial CS at 1, 2, and 3 years from diagnosis.

METHODS:

In this retrospective study, we report longitudinal outcomes of children with moderate-severe UC, initiating oral/IV CS < 1 month of diagnosis and a minimum follow-up (FU) of 1 year. CS resistance (CSR) and CS dependency (CSD) were combined as PR, and those with CS-free remission (CSFR) at 6 months were GR.

RESULTS:

Of 116 children with UC, 76 (33 males) fulfilled study criteria. Median age at diagnosis was 12 years (IQR 12-14), and a median FU was 48 months (IQR 27-65). Thirty-five (46%, CSR = 10, CSD = 25) were PR, and 41 (54%) were GR. Mean relapse (2.39 vs. 1.1, p = 0.0009), acute severe UC flare-up (40% vs. 9.7%, p = 0.002), and colectomy rates (34.2% vs. 2.4%) were greater in PR versus GR, despite frequent early (< 6 months) use of azathioprine (74% vs. 27%, p = 0.004) and anti-TNFs (43% vs. 2.4%, p = 0.0001). Cumulative colectomy at 3 years was lowest in those with GR versus CSD and CSR (2.4% vs. 28% and 50% p = 0.001). On univariate analysis, CRP > 20 mg/L at diagnosis, Mayo Clinical Score > 1 at 3 months, and PR predicted colectomy. On multivariate regression, only baseline CRP > 20 mg/L predicted colectomy (HR 4.9, p = 0.03).

CONCLUSIONS:

Baseline CRP and poor response to initial CS are associated with unfavorable outcomes in children with UC.

KEYWORDS:

Acute severe ulcerative colitis (ASUC); Azathioprine (AZA); CS dependency (CSD); CS resistance (CSR); Corticosteroids (CS); Good responders (GR); Infliximab (IFX); Poor responders (PR)

PMID:
30734233
DOI:
10.1007/s10620-019-05486-w

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