التفاصيل البيبلوغرافية
| العنوان: |
Outcomes Following Acute Severe Colitis at Initial Presentation: A Multi-centre, Prospective, Paediatric Cohort Study. |
| المؤلفون: |
Dhaliwal, Jasbir, Tertigas, Dominique, Carman, Nicholas, Lawrence, Sally, Debruyn, Jennifer C, Wine, Eytan, Church, Peter C, Huynh, Hien Q, Rashid, Mohsin, El-Matary, Wael, Deslandres, Colette, Critch, Jeffrey, Ricciuto, Amanda, Carroll, Matthew W, Benchimol, Eric I, Muise, Aleixo, Jacobson, Kevan, Otley, Anthony R, Vallance, Bruce, Mack, David R |
| المصدر: |
Journal of Crohn's & Colitis; Feb2024, Vol. 18 Issue 2, p233-245, 13p |
| مستخلص: |
Aim To assess contemporary outcomes in children with acute severe ulcerative colitis [ASUC] at initial presentation. Methods Between April 2014 and January 2019, children aged <17 years, with new onset ASUC (Paediatric Ulcerative Colitis Activity Index [PUCAI ≥65) were prospectively followed in a Canadian inception cohort study. 16S rRNA amplicon sequencing captured microbial composition of baseline faecal samples. Primary endpoint was corticosteroid-free clinical remission with intact colon at 1 year [PUCAI <10, no steroids ≥4 weeks]. Results Of 379 children with new onset UC/IBD-unclassified, 105 [28%] presented with ASUC (42% male; median [interquartile range; [IQR]) age 14 [11-16] years; extensive colitis in all). Compared with mild UC, gut microbiome of ASUC patients had lower α-diversity, decreased beneficial anaerobes, and increased aerobes; 54 [51%] children were steroid-refractory and given infliximab [87% intensified regimen]. Corticosteroid-free remission at 1 year was achieved by 62 [61%] ASUC cohort (by 34 [63%] steroid-refractory patients, all on biologics; by 28 [55%] steroid responders,13 [25%] on 5- aminosalicylic acid [5-ASA], 5 [10%] on thiopurines, 10 [20%] on biologics). By 1 year, 78 [74%] escalated to infliximab including 24 [47%] steroid-responders failed by 5-ASA and/or thiopurines. In multivariable analysis, clinical predictors for commencing infliximab included hypoalbuminaemia, greater PUCAI, higher age, and male sex. Over 18 months, repeat corticosteroid course[s] and repeat hospitalisation were less likely among steroid-refractory versus -responsive but -dependent patients (adjusted odds ratio [aOR] 0.71 [95% CI 0.57-0.89] and 0.54 [95% CI 0.45-0.66], respectively). Conclusion The majority of children presenting with ASUC escalate therapy to biologics. Predictors of need for advanced therapy may guide selection of optimal maintenance therapy. [ABSTRACT FROM AUTHOR] |
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