Clusters of Disease Activity and Early Risk Factors of Clinical Course of Pediatric Crohn's Disease.

IF 4.5 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Inflammatory Bowel Diseases Pub Date : 2024-11-04 DOI:10.1093/ibd/izad275
Manuela Distante, Silvia Rotulo, Marco Ranalli, Eugenio Pedace, Paolo Lionetti, Serena Arrigo, Patrizia Alvisi, Erasmo Miele, Massimo Martinelli, Giovanna Zuin, Matteo Bramuzzo, Mara Cananzi, Marina Aloi
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Abstract

Background: This study aimed to define clusters of disease activity and prognostic factors of disease course in a well-characterized cohort of children with Crohn's disease (CD).

Methods: All patients from the SIGENP IBD (Italian Society of Pediatric Gastroenterology Hepatology and Nutrition Inflammatory Bowel Disease) registry with a 5-year follow-up and 6-monthly evaluation were included. Active disease was defined for each semester as follows: clinical activity (weighted Pediatric Crohn's Disease Activity Index ≥12.5 or Mucosal Inflammation Noninvasive Index ≥8) and active disease on endoscopy (Simple Endoscopic Score for Crohn's Disease >3 or fecal calprotectin >250 µg/g) or imaging. Formula-based clusters were generated based on previously published patterns in adults.

Results: Data from 332 patients were analyzed. A total of 105 (32%) experienced a quiescent disease course; 49 (15%) and 31 (9%) a moderate-to-severe chronically active and chronic intermittent disease, respectively; 104 (31%) and 43 (13%) had active disease in the first 2 years after diagnosis and remission thereafter and vice versa, respectively. Surgery at diagnosis was significantly associated with a quiescent course (odds ratio [OR], 10.05; 95% confidence interval [CI], 3.05-25.22; P=.0005), while growth impairment at the diagnosis and active disease requiring corticosteroids at 6 months were inversely related to the quiescent group (OR, 0.48; 95% CI, 0.27-0.81; P= .007; and OR, 0.35; 95% CI, 0.16-0.71; P= .005, respectively). Perianal involvement at diagnosis and moderate-severe activity at 6 months correlated with disease progression (OR, 3.85; 95% CI, 1.20-12.85; P=.02).

Conclusions: During the first 5 years of follow-up, one-third of children with CD experience a quiescent course. However, another one-third have a moderate-to-severe disease course. Surgery at the diagnosis is related to a quiescent course, while growth impairment and lack of response to induction therapy correlate with more severe disease activity during follow-up.

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儿童克罗恩病临床病程的疾病活动群和早期危险因素。
背景:本研究旨在确定具有良好特征的克罗恩病(CD)儿童队列中的疾病活动群和病程预后因素。方法:所有来自SIGENP IBD(意大利儿科胃肠病学肝病和营养炎症性肠病学会)登记的患者进行5年随访和6个月评估。每学期的活动性疾病定义如下:临床活动性(加权儿科克罗恩病活动性指数≥12.5或粘膜炎症无创指数≥8)和内镜活动性疾病(克罗恩病简单内镜评分>3或粪便钙保护蛋白>250µg/g)或影像学。基于公式的聚类是基于先前发表的成人模式生成的。结果:分析了332例患者的资料。共有105例(32%)经历了静止病程;49例(15%)和31例(9%)分别为中度至重度慢性活动性疾病和慢性间歇性疾病;104例(31%)和43例(13%)在诊断后的前2年有活动性疾病,此后缓解,反之亦然。诊断时手术与静止病程显著相关(优势比[OR], 10.05;95%置信区间[CI], 3.05-25.22;P= 0.0005),而诊断时的生长障碍和6个月时需要皮质类固醇的活动性疾病与静止组呈负相关(OR, 0.48;95% ci, 0.27-0.81;P = .007;OR为0.35;95% ci, 0.16-0.71;P= 0.005)。诊断时肛周受累和6个月时中重度活动与疾病进展相关(OR, 3.85;95% ci, 1.20-12.85;P = .02点)。结论:在前5年的随访中,三分之一的乳糜泻患儿处于静止期。然而,另有三分之一的患者病程为中度至重度。诊断时的手术与静止病程有关,而生长障碍和对诱导治疗缺乏反应与随访期间更严重的疾病活动相关。
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来源期刊
Inflammatory Bowel Diseases
Inflammatory Bowel Diseases 医学-胃肠肝病学
CiteScore
9.70
自引率
6.10%
发文量
462
审稿时长
1 months
期刊介绍: Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.
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