gms | German Medical Science

Introduction: The predictors of poor outcome (POPO) have received increasing attention in the last few years. These are criteria that indicate a poor disease course for pediatric patients with Crohn’s Disease. For ulcerative colitis, no POPO criteria have been established so far. The aim of this analysis was to identify POPO criteria and their role in the treatment of pediatric patients.

Methods: To examine the criteria, data from the clinical register CEDATA-GPGE was used. Since 2004, the cohort has documented information on disease progression, diagnosis and treatment of more than 4000 pediatric patients with chronic inflammatory bowel disease (IBD). Data of patients who were reported to the registry within three months of initial diagnosis, had at least two follow-up documentations and one of them within three month after the first report were included in analysis. Unsatisfactory therapeutic results got defined as the need for treatment with azathioprine or 6-mercatopurine, the use of biologics, growth delay (<-2.5 SDS), surgery and lack of remission (> 1 year). In the following, patients meeting the above criteria were compared by recursive partitioning in terms of activity index (PUCAI), family history, extraintestinal manifestation, therapy, general symptoms, complications and Paris-Classification to those patients who have achieved a satisfactory therapeutic outcome.

Results: Of the more than 1537 reported patients with ulcerative colitis, 390 were able to meet the above criteria for inclusion in the analysis. An initial PUCAI of over 60 was associated with both the need for exhibition of azathioprine (AZA) or 6-mercaptopurin (6MP) therapy and treatment side effects.

Administration of biologics and positive family history has been associated with patients with a positive family history.

None of the testes parameters within diagnosis could predict lack of remission more than one year or severe growth retardation. There was also no significant correlation between surgical intervention and any of the tested variables.

Discussion: Clinical registers such as CEDATA-GPGE are of great value for the evaluation and analysis of negative influencing factors. However, the predictors of poor outcome which could be detected were related to the exhibition of AZA, 6MP or biologicals. Further prospective studies are required for the final assessment and evaluation of these criteria.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.