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

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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.

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Acknowledgments

We would like to acknowledge doctors Mews, Ravikumara, and Thacker for providing general support.

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Authors and Affiliations

  1. Gastroenterology Department, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, WA, 6008, Australia

    Gayetri Deva Rajoo, Lian Tan, Ainslie Lopez & Zubin Grover

  2. Gastroenterology Department, Lady Cilento Hospital, Brisbane, 4101, Australia

    Peter Lewindon

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  1. Gayetri Deva Rajoo
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  2. Lian Tan
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Contributions

GDR (10%), LT (10%), AL (0%), ZG (80%), and PL (0%) conceptualized and designed the study; GDR, (40%), LT (40%), AL (5%), ZG (15%), and PL (0%) took part in acquisition of data; GDR, (5%), LT (5%), AL (5%), ZG (85%), and PL (0%) analyzed and interpreted the data; and GDR, (5%), LT (5%), AL (5%), ZG (75%), and PL (10%) drafted the article.

Corresponding author

Correspondence to Zubin Grover.

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The authors Gayetri Deva Rajoo, Lian Tan, Ainslie Lopez, and Zubin Grover declare that they have no conflict of interest.

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Deva Rajoo, G., Tan, L., Lopez, A. et al. Early Response to Corticosteroid and Baseline C-Reactive Protein Predicts Outcomes in Children with Moderate to Severe Ulcerative Colitis. Dig Dis Sci 64, 1929–1937 (2019). https://doi.org/10.1007/s10620-019-05486-w

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  • DOI: https://doi.org/10.1007/s10620-019-05486-w

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