Clinical predictors at diagnosis of disabling pediatric Crohn's disease

Gastroenterology Unit, EPIMAD Registry, Rouen University and Hospital, France.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 11/2012; 18(11):2072-8. DOI: 10.1002/ibd.22898
Source: PubMed


Identification of children with Crohn's disease (CD) at high risk of disabling disease would be invaluable in guiding initial therapy. Our study aimed to identify predictors at diagnosis of a subsequent disabling course in a population-based cohort of patients with pediatric-onset CD.
Among 537 patients with pediatric CD diagnosed at <17 years of age, 309 (57%) with 5-year follow-up were included. Clinical and demographic factors associated with subsequent disabling CD were studied. Three definitions of disabling CD were used: Saint-Antoine and Liège Hospitals' definitions and a new pediatric definition based on the presence at maximal follow-up of: 1) growth delay defined by body mass index (BMI), weight or height lower than -2 SD Z score; and 2) at least one intestinal resection or two anal interventions. Predictors were determined using multivariate analyses and their accuracy using the kappa method considering a relevant value ≥0.6.
According to the Saint-Antoine definition, the rate of disabling CD was 77% and predictors were complicated behavior and L1 location. According to the Liège definition, the rate was 37% and predictors included behavior, upper gastrointestinal disease, and extraintestinal manifestations. According to the pediatric definition, the rate of disabling CD was 15%, and predictors included complicated behavior, age <14, and growth delay at diagnosis. Kappa values for each combination of predictors were, respectively, 0.2, 0.3, and 0.2 and were nonrelevant.
Clinical parameters at diagnosis are insufficient to predict a disabling course of pediatric CD. More complex models including serological and genetic biomarkers should be tested. (Inflamm Bowel Dis 2012;).

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Available from: Mathurin Fumery, Oct 16, 2014
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    • "In this studt, most children with CD showed poor weight gain, as defined by lower BMI at the time of initial diagnosis of IBD. A recent study also documented that BMI is one of the clinical predictors of a subsequently disabling course of CD in children [19]. "
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