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05-08-2010 | Gastroenterology | Article

Clinical variables may help predict colectomy in pediatric UC patients

Abstract

Free abstract

MedWire News: Results from a retrospective cohort study show that children with a high white blood cell (WBC) count and low hematocrit level at diagnosis of ulcerative colitis are at increased risk for colectomy 1-3 years later.

Children with UC tend to have a more severe disease course than adults and therefore identification of variables predicting a poor outcome would be highly beneficial and could allow early introduction of disease modifying therapies to the relevant patients.

In this study, 133 children (18 years or younger) with new-onset UC were enrolled at the Primary Children's Medical Center in Utah.

The researchers evaluated the effects of different clinical variables on UC prognosis at 1 and 3 years, including WBC count, hematocrit level, absolute neutrophil count, erythrocyte sedimentation rate, albumin level, and age, among others.

Colectomy, involving removal of part of the large intestine, is required for some UC patients with more severe disease. The rates of colectomy in the cohort at 1 and 3 years were 16.7% and 35.6%, respectively.

Of the variables measured, WBC count was significantly higher (11.6 versus 9.5) and hematocrit level significantly lower (33.2 versus 36.3) in patients who had a colectomy within 3 years compared with those who had not.

The patients were then classified as being at high or low risk for colectomy based on their combined WBC count and hematocrit risk score. At 1 year, 11.2% of high-risk patients underwent colectomy compared with only 2.4% classified as low-risk. Similarly, at 3 years, 19.2% of high-risk patients underwent colectomy compared with 5.6% of low-risk patients.

Being classified as high-risk for colectomy based on the combined risk score increased the relative risk for colectomy at 1 and 3 years a significant 5.62- and 4.84-fold, respectively.

"Our data reaffirm that a large subset of patients with pediatric-onset UC have severe disease, manifested by the use of immune modulators and a high colectomy rate," write the researchers in the journal Inflammatory Bowel Diseases.

"Appropriate and early risk stratification may guide therapy and perhaps improve the course of disease, optimize immune suppression therapy, and possibly reduce the need for surgery or extend time to colectomy," they conclude.

"The continued search for clinical, immunological, or genetic markers to risk-stratify children with UC is justified."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Helen Albert