# Prediction of Relapse and Steroid Dependency in Pediatric Ulcerative Colitis

## TL;DR

This study identifies factors that predict steroid dependence and relapse in children with ulcerative colitis, suggesting a scoring system could help guide treatment decisions.

## Contribution

The study proposes a novel scoring system incorporating clinical and laboratory parameters to predict steroid dependence in pediatric ulcerative colitis.

## Key findings

- Low IgM levels were inversely correlated with relapse and steroid dependence in pediatric ulcerative colitis patients.
- Steroid dependence was significantly associated with hemoglobin, hematocrit, white blood cell count, and other laboratory parameters.
- MMES was found to be a significant predictor of steroid dependence in patients with pancolitis.

## Abstract

Background and Objectives: The objective of this study is to ascertain the predictive criteria for steroid dependence and relapse in patients diagnosed with ulcerative colitis. Additionally, the study aims to provide data that will enable earlier transition to second-line treatment when necessary. Materials and Methods: The study included 62 patients diagnosed with ulcerative colitis between 2018 and 2023, who were followed up at the Department of Pediatric Gastroenterology, Hepatology, and Nutrition at the University of Health Sciences, Izmir Dr. Behçet Uz Children’s Hospital. Demographic data included age and gender at diagnosis, BMI, weight-for-age, and height-for-age. Laboratory parameters recorded were complete blood count, total protein, albumin, CRP, ESR, IgG, IgM, IgA, IgG subclasses, vitamin D, B12, folic acid, and ferritin levels. Results: The study included 62 patients. Thirty-two patients (51.6%) were female. In the univariate regression analysis, there was an inverse correlation between IgM levels and relapse and steroid dependence (p < 0.01, p = 0.03, respectively). Additionally, a relationship was identified between steroid dependence and hemoglobin, hematocrit, white blood cell count, neutrophil count, platelet count, and albumin levels (p = 0.01, p < 0.01, p < 0.01, p = 0.01, p < 0.01, p = 0.03, respectively). There was a significant relationship between MMES and steroid dependence (p < 0.01). MMES was found to be significant in predicting steroid dependence in patients with pancolitis (AUC: 0.75, 95% CI: [0.60–0.90], p = 0.01). Conclusions: We conclude, as for Crohn’s disease, an algorithm or a specific scoring system for ulcerative colitis is needed for the use of anti-TNF drugs as first-line treatment in pediatric ulcerative colitis. The initial severity of the disease appears to be the most important risk factor in terms of steroid dependence. Based on our study and the literature data, a scoring system incorporating parameters such as hemoglobin, hematocrit, WBC, albumin, platelet, and IgM levels, disease involvement type, initial PUCAI score, and MMES would be prudent to adopt.