Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
Eur J Pediatr. 2020 Jan;179(1):157-164. doi: 10.1007/s00431-019-03491-9. Epub 2019 Nov 11.
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.
炎症性肠病 (IBD) 恶化可导致住院时间延长和复杂化。尚未详细描述与恶化相关的住院特征和预测儿科患者因 IBD 住院治疗结局不佳的因素。
我们纳入了 2004 年至 2017 年期间在一家三级转诊中心因 IBD 恶化而住院的所有儿童。回顾性分析了入院前和入院期间的人口统计学和疾病特征，以及住院期间的病程，包括实验室检查、诊断性检查和治疗。不良结局定义为住院时间延长（≥7 天）和/或住院期间需要手术。
共有 78 例 IBD 患儿的 181 次住院，中位数（IQR）年龄为 14.8（11.8-16.2）岁。其中 53 例（67.9%）为克罗恩病，25 例（32.1%）为溃疡性结肠炎。
多变量分析显示，住院时疾病活动度严重（比值比[OR] = 3.33，P = 0.013）、体重百分位数较低（OR = 0.98，P = 0.009）、接受抗生素治疗（OR = 5.03，P = 0.001）、输血（OR = 8.03，P = 0.003）、住院期间进行内镜检查（OR = 2.73，P = 0.027）和影像学检查（OR = 3.61，P = 0.001）可预测住院时间延长。16 例患儿（8.8%）因穿透性（OR = 7.73，P = 0.019）和狭窄性疾病（OR = 12.38，P <0.001）而接受手术干预。
我们确定了因 IBD 住院的儿童不良结局的预测因素。在入院时可以测量的变量中，严重的疾病活动是最重要的预测指标。识别这些预测因素可能有助于调整患者的管理。
炎症性肠病（IBD）患者可能因疾病恶化或治疗相关并发症而需要住院治疗。
IBD 患者的住院治疗给患者及其家庭带来了沉重的情感负担。
低体重百分位数、严重的疾病活动和较低的白蛋白水平是 IBD 患儿住院时间延长的预测因素。
识别这些预测因素可能有助于调整患者的管理。
