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PUCAI effectively predicted disease outcome in children
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The Pediatric Ulcerative Colitis Activity Index was a strong predictor of disease outcome and identifier of patient subsets most likely to benefit from early aggressive treatment, according to recent study data.
Researchers conducted a chart review of 115 patients (mean age, 11 years) with new onset pediatric ulcerative colitis (UC) to evaluate early endoscopic and clinical predictors for 1-year sustained steroid-free remission (SSFR). The Pediatric Ulcerative Colitis Activity Index (PUCAI) was used to evaluate patients at UC diagnosis and at 3 months. Disease activity was categorized as severe (≥65), moderate (<65), mild (<35) or in remission (<10).
Of the predictive variables assessed (PUCAI, endoscopic severity at diagnosis, disease extent, age, standard blood tests at diagnosis and 3 months), only PUCAI was consistent for predictability. The 3-month PUCAI was the most accurate predictor of SSFR (AUC=0.7; 95% CI, 0.6-0.8) and colectomy by 2 years (AUC=0.75; 95% CI, 0.6-0.89). SSFR was achieved in 17% of patients with active disease at 3 months (negative predictive value=83%) and in 8.6% of those with a PUCAI score of greater than 10 (NPV=91%; positive predictive value=52%; P<.001). PUCAI scores also were greater in steroid-dependent patients at 3 months (32 ± 27 points) compared with those who were not (10 ± 14; P<.001). All patients with a PUCAI score greater than 60 had a poor 1-year outcome, and 95% with a score of less than 35 had a good outcome.
“We have found that although variables reflecting disease severity at baseline have some predictive power for some of the outcomes, it is the short-term response to initial induction treatment that is most predictive,” the investigators concluded. “A 3-month PUCAI defined remission was a strong and consistent predictor of disease outcome.
Based on these results, the researchers recommended that patients “with a PUCAI≥10 should be considered for treatment optimization and escalation to achieve complete clinical remission.”
Disclosure: Researcher Dan Turner, MD, PhD, is one of the inventors of the PUCAI, which is copyrighted to the Hospital for Sick Children, Toronto.
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