P852 predictors of complicated disease course in UC in an administrative database: a nationwide study from the epi-IIRN
Lujan, R.(1)*;Atia, O.(1);Focht, G.(1);Greenfeld, S.(2);Kariv, R.(2);Loewenberg Weisband, Y.(3);Lederman, N.(4);Matz, E.(5);Dotan, I.(6);Turner, D.(1);
(1)Shaare Zedek Medical Center, Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Jerusalem, Israel;(2)Israel and the Sackler Faculty of Medicine, Maccabi Health Services, Tel Aviv, Israel;(3)Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel;(4)Medical Division, Meuhedet Sick Fund, Tel Aviv, Israel;(5)Leumit Health Services, Leumit Health Services, Tel Aviv, Israel;(6)Rabin Medical Center and the Sackler Faculty of Medicine, Division of Gastroenterology, Petah Tikva, Israel;
There is uncertainty about the ability to predict disease course in UC, often since prediction studies are small and include selected population. We aimed to use a large nationwide cohort to explore predictors of disease course in UC.
Data of patients diagnosed with UC in the epi-IIRN cohort 2005-2020 were retrieved from the four Israeli Health-Maintenance-Organizations covering 98% of the population. The following potential predictors were explored: demographic data, laboratory results, induction medications, and extra-intestinal manifestations. The primary outcome was complicated disease course defined as colectomy, steroid-dependency, or need for more than one biologic class. Hierarchical clustering categorized disease severity at diagnosis based on available laboratory results into four groups of disease severity (mild, moderate, severe, and extreme).
A total of 15,111 UC patients with 114,208 person-years of follow-up were included, of whom 2,213 (14%) had complicated disease course. The latter was predicted in a Cox multivariable regression model by induction therapy with biologics (HR 3.84 [2.4-6.12]) and severity of laboratory tests prior to diagnosis (HR 1.41 [1.03-1.92]). The use of topical treatment (5-ASA or steroids enema/suppository) as monotherapy was protective with a decreased risk of complicated disease course (compared with untreated, HR 0.5 [0.38-0.63). Younger age of diagnosis (HR of pediatric-onset compared to adult-onset 1.79 [1.48-2.15]) and recent year of diagnosis (HR 1.03 [1-1.04]) were also associated with complicated outcome. Jews had 23% reduced risk of complicated disease course compared with Arabs (HR 0.77 [0.60-0.97]) (Figure 1). Specifically in the laboratory tests, there was a gradual increase in complicated disease amongst the disease severity clusters (p<0.001; Figure 2).
In this nationwide cohort, complicated disease course was apparent in 14% of patients and predicted by serum laboratory tests and induction therapy with biologics. Jewish ethnicity and topic therapy (reflecting proctitis) were associated with better outcomes.