Journal of pediatric gastroenterology and nutrition · 2026
Risk factors at diagnosis for progression to severe colitis and colectomy in children and young adult patients with mild-moderate disease.
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Amirikian Karine, Choi Jaeun, Xie Xianhong, Kim Mimi, Tomer Gitit, ImproveCareNow Pediatric IBD Learning Health System
Аннотация
OBJECTIVES: Pediatric ulcerative colitis (UC) has a more severe and unpredictable course than adult-onset disease. This study aimed to identify baseline and time-varying risk factors for the development of severe disease or colectomy among children and young adults with mild to moderate UC.
METHODS: We conducted a retrospective analysis using data from ImproveCareNow (ICN), a multicenter pediatric inflammatory bowel disease registry (2009-2019). Inclusion criteria were UC diagnosis within 3 months of enrollment, age <21 years, at least 1 year of follow-up, pediatric ulcerative colitis activity index (PUCAI) score at each visit and mild to moderate disease. Cox proportional hazard models were fit to analyze risk factors for developing a severe outcome, defined as PUCAI ≥ 65 or colectomy.
RESULTS: Out of 13,075 patients with UC, 1401 met inclusion criteria, among whom 165 (11.8%) patients developed a severe outcome (125 [9%] with PUCAI≥65; 40 [2.8%] with colectomy). Each 15-point increase in PUCAI at enrollment conferred a 1.52 times increased risk of having a severe outcome (95% confidence interval [CI] for hazard ratio [HR]: 1.28-1.81; p < 0.0001). Use of systemic steroids significantly increased the risk (HR: 13.61; 95% CI: 9.01-20.56; p < 0.0001) as did budesonide (HR: 4.77; 95% CI: 2.39-9.50; p < 0.0001). Use of oral aminosalicylates (HR: 0.46; 95% CI: 0.31-0.70; p = 0.0002) and immunomodulators (HR: 0.56; 95% CI: 0.36-0.89; p = 0.01) was associated with reduced risk. Black patients had a higher risk of developing a severe outcome compared to White patients (HR: 1.74; 95% CI: 1.01-2.99; p = 0.047).
CONCLUSIONS: Steroid use, higher PUCAI, and Black race were associated with elevated risk of a severe outcome, while immunomodulators or oral aminosalicylates use was associated with decreased risk. These factors should be considered when developing treatment plans.
METHODS: We conducted a retrospective analysis using data from ImproveCareNow (ICN), a multicenter pediatric inflammatory bowel disease registry (2009-2019). Inclusion criteria were UC diagnosis within 3 months of enrollment, age <21 years, at least 1 year of follow-up, pediatric ulcerative colitis activity index (PUCAI) score at each visit and mild to moderate disease. Cox proportional hazard models were fit to analyze risk factors for developing a severe outcome, defined as PUCAI ≥ 65 or colectomy.
RESULTS: Out of 13,075 patients with UC, 1401 met inclusion criteria, among whom 165 (11.8%) patients developed a severe outcome (125 [9%] with PUCAI≥65; 40 [2.8%] with colectomy). Each 15-point increase in PUCAI at enrollment conferred a 1.52 times increased risk of having a severe outcome (95% confidence interval [CI] for hazard ratio [HR]: 1.28-1.81; p < 0.0001). Use of systemic steroids significantly increased the risk (HR: 13.61; 95% CI: 9.01-20.56; p < 0.0001) as did budesonide (HR: 4.77; 95% CI: 2.39-9.50; p < 0.0001). Use of oral aminosalicylates (HR: 0.46; 95% CI: 0.31-0.70; p = 0.0002) and immunomodulators (HR: 0.56; 95% CI: 0.36-0.89; p = 0.01) was associated with reduced risk. Black patients had a higher risk of developing a severe outcome compared to White patients (HR: 1.74; 95% CI: 1.01-2.99; p = 0.047).
CONCLUSIONS: Steroid use, higher PUCAI, and Black race were associated with elevated risk of a severe outcome, while immunomodulators or oral aminosalicylates use was associated with decreased risk. These factors should be considered when developing treatment plans.