Prognostic factors

IBD Curriculum Topic 1.2

Factors conferring an adverse prognosis

The factors below are derived from many different studies, and it is not certain whether all are truly independent risk factors

  • Age of onset < 16y
  • Disease activity during initial 2 y (predicts active disease for 5 y)
  • Quiescent colitis with an acute (rather than chronic) inflammatory cell infiltrate predicts relapse during following year in 50% vs. 25%
  • PSC increases risk of colon cancer (ECCO 2C, beneath)
  • NSAID use (ECCO 3B, beneath)
  • Ex-smokers (perhaps more than those who have never smoked)
  • CRP >10 mg/L after 1 y of extensive colitis (increased rate of surgery)
  • Deep ulceration at endoscopy (poorer outcome and increased chance of surgery)
  • Appendiceal inflammation increases risk of pouchitis
  • Backwash ileitis (present in 20% of patients with pancolitis)
  • Post-therapeutic endoscopic mucosal healing predicts benign disease course (ECCO 3J, beneath)

Factors conferring a beneficial prognosis

  • Age of onset > 40y (lower colectomy risk)
  • Appendectomy prior to disease onset (ECCO 3B, beneath)
  • Tobacco smoking
  • Appendiceal inflammation associated with more responsive disease course {10}
  • Endoscopically confirmed remission
ECCO statement 3B (UC 2017)

A family history of ulcerative colitis or Crohn’s disease increases the risk for developing ulcerative colitis [EL2]. Appendicectomy for proven appendicitis before adulthood, and smoking, reduce the risk and severity of UC [EL3]. Smoking cessation may predispose to ulcerative colitis [EL3]

Risk factors for colectomy

  • > 8 stools / day, or CRP>45 mg/L with 3-8 stools / day, 48-72 h after admission highly predictive for colectomy if treatment limited to steroids
  • 75% chance colectomy with dilatation transverse colon > 5.5cm or mucosal islands 24 h after admission; or >2 gas-filled small bowel loops on abdominal X-ray (AXR) during admission
  • Severe ulceration increases risk of colectomy (from ≈25% to > 90% in one study)
  • Steroid-dependence
  • CRP ≥20 mg/L
  • Moderate to severe UC with a duration ≤3 y
  • Lack of mucosal healing at 1 y

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