Complicated Disease and Response to Initial Therapy Predicts Early Surgery in Paediatric Crohn's Disease: Results From the Porto Group GROWTH Study

Arie Levine, Neil Chanchlani, Seamus Hussey, Tomer Ziv-Baran, Johanna C. Escher, Jorge Amil Dias, Gabor Veres, Sibylle Koletzko, Dan Turner, Kaija Leena Kolho, Anders Paerregaard, Annamaria Staiano, Paolo Lionetti, Federica Nuti, Malgorata Sladek, Ron Shaoul, Isabella Lazowska-Prezeorek, Javier Martin de Carpi, Rotem Sigall Boneh, Tamar Pfeffer GikNoa Cohen-Dolev, Richard K. Russell

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: The ability to predict risk for poor outcomes in Crohn's disease [CD] would enable early treatment intensification. We aimed to identify children with CD with complications at baseline and throughout the study period who are at risk for surgery 2 years from diagnosis. METHODS: Newly diagnosed children with CD were enrolled into a prospective, multicentre inception cohort. Disease characteristics and serological markers were obtained at baseline and week 12 thereafter. Outcome data including disease activity, therapies, complications and need for surgery were collected until the end of 104 weeks. A chi-square automatic interaction detection [CHAID] algorithm was used to develop a prediction model for early surgery. RESULTS: Of 285 children enrolled, 31 [10.9%] required surgery within 2 years. Multivariate analysis identified stricturing disease at baseline (odds ratio [OR] 5.26, 95% confidence interval [CI] 2.02-13.67 [p = 0.001]), and Paediatric Crohn's Disease Activity Index [PCDAI] >10 at week 12 (OR 1.06, 95% CI 1.02-1.10 [p = 0.005]) as key predictors for early surgery. CHAID demonstrated that absence of strictures at diagnosis [7.6%], corticosteroid-free remission at week 12 [4.1%] and early immunomodulator therapy [0.8%] were associated with the lowest risk of surgery, while stricturing disease at diagnosis [27.1%, p < 0.001] or elevated PCDAI at week 12 [16.7%, p = 0.014] had an increased risk of surgery at follow-up. Anti-OmpC status further stratified high-risk patients. DISCUSSION: A risk algorithm using clinical and serological variables at diagnosis and week 12 can categorize patients into high- and low-risk groups from diagnosis.

Original languageEnglish
Pages (from-to)71-78
Number of pages8
JournalJournal of Crohn's & colitis
Volume14
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

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Crohn Disease
Therapeutics
Odds Ratio
Confidence Intervals
Pediatric Crohn's disease
Immunologic Factors
Secondary Prevention
Adrenal Cortex Hormones
Pathologic Constriction
Multivariate Analysis

Keywords

  • child
  • complications
  • Crohn
  • Crohn’s Disease inflammatory bowel disease
  • relapse
  • serological markers
  • surgery

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Complicated Disease and Response to Initial Therapy Predicts Early Surgery in Paediatric Crohn's Disease : Results From the Porto Group GROWTH Study. / Levine, Arie; Chanchlani, Neil; Hussey, Seamus; Ziv-Baran, Tomer; Escher, Johanna C.; Amil Dias, Jorge; Veres, Gabor; Koletzko, Sibylle; Turner, Dan; Kolho, Kaija Leena; Paerregaard, Anders; Staiano, Annamaria; Lionetti, Paolo; Nuti, Federica; Sladek, Malgorata; Shaoul, Ron; Lazowska-Prezeorek, Isabella; Martin de Carpi, Javier; Sigall Boneh, Rotem; Pfeffer Gik, Tamar; Cohen-Dolev, Noa; Russell, Richard K.

In: Journal of Crohn's & colitis, Vol. 14, No. 1, 01.01.2020, p. 71-78.

Research output: Contribution to journalArticle

Levine, A, Chanchlani, N, Hussey, S, Ziv-Baran, T, Escher, JC, Amil Dias, J, Veres, G, Koletzko, S, Turner, D, Kolho, KL, Paerregaard, A, Staiano, A, Lionetti, P, Nuti, F, Sladek, M, Shaoul, R, Lazowska-Prezeorek, I, Martin de Carpi, J, Sigall Boneh, R, Pfeffer Gik, T, Cohen-Dolev, N & Russell, RK 2020, 'Complicated Disease and Response to Initial Therapy Predicts Early Surgery in Paediatric Crohn's Disease: Results From the Porto Group GROWTH Study', Journal of Crohn's & colitis, vol. 14, no. 1, pp. 71-78. https://doi.org/10.1093/ecco-jcc/jjz111
Levine, Arie ; Chanchlani, Neil ; Hussey, Seamus ; Ziv-Baran, Tomer ; Escher, Johanna C. ; Amil Dias, Jorge ; Veres, Gabor ; Koletzko, Sibylle ; Turner, Dan ; Kolho, Kaija Leena ; Paerregaard, Anders ; Staiano, Annamaria ; Lionetti, Paolo ; Nuti, Federica ; Sladek, Malgorata ; Shaoul, Ron ; Lazowska-Prezeorek, Isabella ; Martin de Carpi, Javier ; Sigall Boneh, Rotem ; Pfeffer Gik, Tamar ; Cohen-Dolev, Noa ; Russell, Richard K. / Complicated Disease and Response to Initial Therapy Predicts Early Surgery in Paediatric Crohn's Disease : Results From the Porto Group GROWTH Study. In: Journal of Crohn's & colitis. 2020 ; Vol. 14, No. 1. pp. 71-78.
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abstract = "INTRODUCTION: The ability to predict risk for poor outcomes in Crohn's disease [CD] would enable early treatment intensification. We aimed to identify children with CD with complications at baseline and throughout the study period who are at risk for surgery 2 years from diagnosis. METHODS: Newly diagnosed children with CD were enrolled into a prospective, multicentre inception cohort. Disease characteristics and serological markers were obtained at baseline and week 12 thereafter. Outcome data including disease activity, therapies, complications and need for surgery were collected until the end of 104 weeks. A chi-square automatic interaction detection [CHAID] algorithm was used to develop a prediction model for early surgery. RESULTS: Of 285 children enrolled, 31 [10.9{\%}] required surgery within 2 years. Multivariate analysis identified stricturing disease at baseline (odds ratio [OR] 5.26, 95{\%} confidence interval [CI] 2.02-13.67 [p = 0.001]), and Paediatric Crohn's Disease Activity Index [PCDAI] >10 at week 12 (OR 1.06, 95{\%} CI 1.02-1.10 [p = 0.005]) as key predictors for early surgery. CHAID demonstrated that absence of strictures at diagnosis [7.6{\%}], corticosteroid-free remission at week 12 [4.1{\%}] and early immunomodulator therapy [0.8{\%}] were associated with the lowest risk of surgery, while stricturing disease at diagnosis [27.1{\%}, p < 0.001] or elevated PCDAI at week 12 [16.7{\%}, p = 0.014] had an increased risk of surgery at follow-up. Anti-OmpC status further stratified high-risk patients. DISCUSSION: A risk algorithm using clinical and serological variables at diagnosis and week 12 can categorize patients into high- and low-risk groups from diagnosis.",
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AU - Levine, Arie

AU - Chanchlani, Neil

AU - Hussey, Seamus

AU - Ziv-Baran, Tomer

AU - Escher, Johanna C.

AU - Amil Dias, Jorge

AU - Veres, Gabor

AU - Koletzko, Sibylle

AU - Turner, Dan

AU - Kolho, Kaija Leena

AU - Paerregaard, Anders

AU - Staiano, Annamaria

AU - Lionetti, Paolo

AU - Nuti, Federica

AU - Sladek, Malgorata

AU - Shaoul, Ron

AU - Lazowska-Prezeorek, Isabella

AU - Martin de Carpi, Javier

AU - Sigall Boneh, Rotem

AU - Pfeffer Gik, Tamar

AU - Cohen-Dolev, Noa

AU - Russell, Richard K.

PY - 2020/1/1

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N2 - INTRODUCTION: The ability to predict risk for poor outcomes in Crohn's disease [CD] would enable early treatment intensification. We aimed to identify children with CD with complications at baseline and throughout the study period who are at risk for surgery 2 years from diagnosis. METHODS: Newly diagnosed children with CD were enrolled into a prospective, multicentre inception cohort. Disease characteristics and serological markers were obtained at baseline and week 12 thereafter. Outcome data including disease activity, therapies, complications and need for surgery were collected until the end of 104 weeks. A chi-square automatic interaction detection [CHAID] algorithm was used to develop a prediction model for early surgery. RESULTS: Of 285 children enrolled, 31 [10.9%] required surgery within 2 years. Multivariate analysis identified stricturing disease at baseline (odds ratio [OR] 5.26, 95% confidence interval [CI] 2.02-13.67 [p = 0.001]), and Paediatric Crohn's Disease Activity Index [PCDAI] >10 at week 12 (OR 1.06, 95% CI 1.02-1.10 [p = 0.005]) as key predictors for early surgery. CHAID demonstrated that absence of strictures at diagnosis [7.6%], corticosteroid-free remission at week 12 [4.1%] and early immunomodulator therapy [0.8%] were associated with the lowest risk of surgery, while stricturing disease at diagnosis [27.1%, p < 0.001] or elevated PCDAI at week 12 [16.7%, p = 0.014] had an increased risk of surgery at follow-up. Anti-OmpC status further stratified high-risk patients. DISCUSSION: A risk algorithm using clinical and serological variables at diagnosis and week 12 can categorize patients into high- and low-risk groups from diagnosis.

AB - INTRODUCTION: The ability to predict risk for poor outcomes in Crohn's disease [CD] would enable early treatment intensification. We aimed to identify children with CD with complications at baseline and throughout the study period who are at risk for surgery 2 years from diagnosis. METHODS: Newly diagnosed children with CD were enrolled into a prospective, multicentre inception cohort. Disease characteristics and serological markers were obtained at baseline and week 12 thereafter. Outcome data including disease activity, therapies, complications and need for surgery were collected until the end of 104 weeks. A chi-square automatic interaction detection [CHAID] algorithm was used to develop a prediction model for early surgery. RESULTS: Of 285 children enrolled, 31 [10.9%] required surgery within 2 years. Multivariate analysis identified stricturing disease at baseline (odds ratio [OR] 5.26, 95% confidence interval [CI] 2.02-13.67 [p = 0.001]), and Paediatric Crohn's Disease Activity Index [PCDAI] >10 at week 12 (OR 1.06, 95% CI 1.02-1.10 [p = 0.005]) as key predictors for early surgery. CHAID demonstrated that absence of strictures at diagnosis [7.6%], corticosteroid-free remission at week 12 [4.1%] and early immunomodulator therapy [0.8%] were associated with the lowest risk of surgery, while stricturing disease at diagnosis [27.1%, p < 0.001] or elevated PCDAI at week 12 [16.7%, p = 0.014] had an increased risk of surgery at follow-up. Anti-OmpC status further stratified high-risk patients. DISCUSSION: A risk algorithm using clinical and serological variables at diagnosis and week 12 can categorize patients into high- and low-risk groups from diagnosis.

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