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Predictors for poor outcome of hospitalized children with inflammatory bowel disease

  • Anat Yerushalmy-Feler
  • Dana Singer
  • Gil Berkovitch
  • Ronit Lubetzky
  • Iris Dotan
  • Tomer Ziv-Baran
  • Shlomi CohenEmail author
Original Article

Abstract

Inflammatory bowel disease (IBD) exacerbations may lead to prolonged and complicated hospitalizations. The characteristics of exacerbation-related hospitalizations and predictors for poor outcome of pediatric patients hospitalized due to IBD have not been thoroughly described. All children who were hospitalized due to IBD exacerbation in a tertiary referral center between 2004 and 2017 were enrolled. Data on demographic and disease characteristics before and during hospitalization were retrospectively reviewed, as was the course of hospitalization, including laboratory findings, diagnostic work-up, and management. Poor outcomes were defined as prolonged hospitalization (≥ 7 days) and/or the need for surgery during hospitalization. There were 181 hospitalizations of 78 IBD children with a median (IQR) age of 14.8 (11.8–16.2) years. They included 53 (67.9%) with Crohn’s disease and 25 (32.1%) with ulcerative colitis. In a multivariate analysis, severe disease activity at hospitalization (odds ratio [OR] = 3.33, P = 0.013), lower weight percentile (OR = 0.98, P = 0.009), treatment with antibiotics (OR = 5.03, P = 0.001), blood transfusion (OR = 8.03, P = 0.003), undergoing endoscopy (OR = 2.73, P = 0.027), and imaging studies during hospitalization (OR = 3.61, P = 0.001) predicted prolonged hospitalization. Surgical intervention was performed in 16 patients (8.8%), due to penetrating (OR = 7.73, P = 0.019) and stricturing disease (OR = 12.38, P < 0.001).

Conclusion: We identified predictors for poor outcomes of children hospitalized due to IBD. Among the variables that can be measured at the beginning of the admission, severe disease activity was the most significant predictor recognition of these predictors that may contribute to modification of patient management.

What is Known:

• Inflammatory bowel disease (IBD) patients may require hospitalization due to disease exacerbation or treatment-related complications.

• Hospitalizations of IBD patients constitute a heavy emotional burden on patients and families.

What is New:

• Lower weight percentile, severe disease activity, and a lower albumin level were predictors for prolonged hospitalization in children with IBD.

• Recognition of these predictors may contribute to modification of patient management.

Keywords

Children Hospitalization Crohn’s disease Ulcerative colitis Outcome predictors 

Abbreviations

IBD

Inflammatory bowel diseases

CD

Crohn’s disease

UC

Ulcerative colitis

ESPGHAN

European Society for Pediatric Gastroenterology Hepatology and Nutrition

PCDAI

Pediatric CD activity index

PUCAI

Pediatric UC activity index

SD

Standard deviation

IQR

Interquartile range

GEE

Generalized estimating equation

CT

Computed tomography

MRI

Magnetic resonance imaging

GI

Gastrointestinal

CRP

C-reactive protein

Notes

Authors’ contributions

AYF, DS, GB, RL, ID, TZB, SC- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation ofdata for the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work; All authors discussed the results and commented on the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatric Gastroenterology Unit, “Dana-Dwek” Children’s HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael
  2. 2.Department of Pediatrics, “Dana-Dwek” Children’s HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael
  3. 3.Division of GastroenterologyRabin Medical CenterPetah TikvaIsrael
  4. 4.Department of Epidemiology and Preventive Medicine, School of Public HealthTel Aviv UniversityTel AvivIsrael
  5. 5.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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