Abstract
Background
This study aimed to define clusters of disease activity and prognostic factors of disease course in a well-characterized cohort of children with Crohn’s disease (CD).
Methods
All ...patients from the SIGENP IBD (Italian Society of Pediatric Gastroenterology Hepatology and Nutrition Inflammatory Bowel Disease) registry with a 5-year follow-up and 6-monthly evaluation were included. Active disease was defined for each semester as follows: clinical activity (weighted Pediatric Crohn’s Disease Activity Index ≥12.5 or Mucosal Inflammation Noninvasive Index ≥8) and active disease on endoscopy (Simple Endoscopic Score for Crohn’s Disease >3 or fecal calprotectin >250 µg/g) or imaging. Formula-based clusters were generated based on previously published patterns in adults.
Results
Data from 332 patients were analyzed. A total of 105 (32%) experienced a quiescent disease course; 49 (15%) and 31 (9%) a moderate-to-severe chronically active and chronic intermittent disease, respectively; 104 (31%) and 43 (13%) had active disease in the first 2 years after diagnosis and remission thereafter and vice versa, respectively. Surgery at diagnosis was significantly associated with a quiescent course (odds ratio OR, 10.05; 95% confidence interval CI, 3.05-25.22; P=.0005), while growth impairment at the diagnosis and active disease requiring corticosteroids at 6 months were inversely related to the quiescent group (OR, 0.48; 95% CI, 0.27-0.81; P= .007; and OR, 0.35; 95% CI, 0.16-0.71; P= .005, respectively). Perianal involvement at diagnosis and moderate–severe activity at 6 months correlated with disease progression (OR, 3.85; 95% CI, 1.20-12.85; P=.02).
Conclusions
During the first 5 years of follow-up, one-third of children with CD experience a quiescent course. However, another one-third have a moderate-to-severe disease course. Surgery at the diagnosis is related to a quiescent course, while growth impairment and lack of response to induction therapy correlate with more severe disease activity during follow-up.
Patient follow-up after intensive care unit (ICU) discharge allows the early recognition of complications associated to post-intensive care syndrome (PICS). The aim of this project is to standardize ...outcome variables in a follow-up program for patients at risk of suffering PICS.
The Rehabilitation and Patient Follow-up Committee of the Argentine Society of Intensive Care Medicine (Sociedad Argentina de Terapia Intensiva, SATI) requested the collaboration of different committees to design the present document. A thorough search of the literature on the issue, together with pre-scheduled meetings and web-based discussion encounters were carried out. After comprehensive evaluation, the recommendations according to the GRADE system included in the follow-up program were: frequency of controlled visits, appointed healthcare professionals, basic domains of assessment and recommended tools of evaluation, validated in Spanish, and entire duration of the program.
The measures herein suggested for patient follow-up after ICU discharge will facilitate a basic approach to diagnosis and management of the long-term complications associated to PICS.
Abstract
Background
This study aimed to define clusters of disease activity and prognostic factors of the disease course in a well-characterized cohort of children with Crohn’s disease (CD).
Methods
...All patients with CD identified from the SIGENP IBD registry with a follow-up of at least 5 years and a 6-monthly evaluation were included. Active disease was defined for each yearly semester as follows: clinical activity (wPCDAI≥12,5 or MINI index ≥8), need for treatment escalation, hospitalization, or surgery, active disease on endoscopy (SES-CD >3) or imaging. Formula-based clusters were generated based on previously published patterns in adults 1. Prediction models were created based on clinical, surgical, endoscopic, and laboratory findings at diagnosis and at 6-month follow-up.
Results
Data from 332 patients were analyzed. Ninety-six (29%) had a quiescent course; 52 (16%) and 34 (10%) had a moderate-to-severe chronically active and chronic intermittent disease; 107 (32%) and 43 (13%) had an active disease in the first two years after diagnosis and remission thereafter and the opposite course, respectively. Overall, 129 (39%) children presented with an active disease at 5 years of follow-up, with no patient off-therapy. Surgery at the time of diagnosis was significantly associated with a quiescent course OR 10.05 (CI 3,05-25,22), p 0.0005, while growth impairment at the diagnosis and moderate-severe activity requiring corticosteroids at 6 months were inversely related to the quiescent group OR 0.48 (CI 0,27-0,81) p 0.007 and OR 0.35 (CI 0,16-0,71) p 0.005, respectively. Perianal involvement at diagnosis and moderate-severe activity at 6 months positively correlated with disease progression (i.e., B1 to B2/B3) at follow-up OR 2.55 (CI 1,05-6,07) p<0.04 and OR 3.85 (CI 1,20-12,85) p 0.02. Seventy-three patients (22%) required surgery, of which 31 (43%) in the first 6 months after diagnosis.
Conclusion
Approximately one-third of our cohort of children with CD had a quiescent course during the first five years after diagnosis. In contrast, more than one-third of the patients had a chronically or intermittently active disease during the entire follow-up, or an initial remission followed by a persistent activity. Surgery at the time of diagnosis, mild disease onset without growth impairment, and lower disease activity without corticosteroid use in the first six months after diagnosis predicted a quiescent course over time.
1. Wintjens D., Bergey F., Saccenti E. et al. Disease activity patterns of Crohn's disease in the first ten years after diagnosis in the population-based IBD South Limbrug Cohort. J Crohns Colitis. 2021; 15 (3):391-400.
This paper analyzes the challenges to deployment of PV in Argentina. We discuss current changes in the PV market as well as financial, technical and regulatory factors that both favor and act as ...barriers to growth. We identify several significant factors that are enabling PV penetration, particularly projects directed at easing PV grid connection.
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