Early Response to Corticosteroid and Baseline C-Reactive Protein Predicts Outcomes in Children with Moderate to Severe Ulcerative Colitis

  • Gayetri Deva Rajoo
  • Lian Tan
  • Ainslie Lopez
  • Peter Lewindon
  • Zubin GroverEmail author
Original Article



Initial response to corticosteroids (CS) is recognized as a strong predictor of outcomes in ulcerative colitis (UC).


To compare outcomes of early poor responders (PR) versus good responders (GR) to initial CS at 1, 2, and 3 years from diagnosis.


In this retrospective study, we report longitudinal outcomes of children with moderate–severe UC, initiating oral/IV CS < 1 month of diagnosis and a minimum follow-up (FU) of 1 year. CS resistance (CSR) and CS dependency (CSD) were combined as PR, and those with CS-free remission (CSFR) at 6 months were GR.


Of 116 children with UC, 76 (33 males) fulfilled study criteria. Median age at diagnosis was 12 years (IQR 12–14), and a median FU was 48 months (IQR 27–65). Thirty-five (46%, CSR = 10, CSD = 25) were PR, and 41 (54%) were GR. Mean relapse (2.39 vs. 1.1, p = 0.0009), acute severe UC flare-up (40% vs. 9.7%, p = 0.002), and colectomy rates (34.2% vs. 2.4%) were greater in PR versus GR, despite frequent early (< 6 months) use of azathioprine (74% vs. 27%, p = 0.004) and anti-TNFs (43% vs. 2.4%, p = 0.0001). Cumulative colectomy at 3 years was lowest in those with GR versus CSD and CSR (2.4% vs. 28% and 50% p = 0.001). On univariate analysis, CRP > 20 mg/L at diagnosis, Mayo Clinical Score > 1 at 3 months, and PR predicted colectomy. On multivariate regression, only baseline CRP > 20 mg/L predicted colectomy (HR 4.9, p = 0.03).


Baseline CRP and poor response to initial CS are associated with unfavorable outcomes in children with UC.


Corticosteroids (CS) CS resistance (CSR) CS dependency (CSD) Good responders (GR) Poor responders (PR) Acute severe ulcerative colitis (ASUC) Azathioprine (AZA) Infliximab (IFX) 



We would like to acknowledge doctors Mews, Ravikumara, and Thacker for providing general support.

Author's contribution

GDR (10%), LT (10%), AL (0%), ZG (80%), and PL (0%) conceptualized and designed the study; GDR, (40%), LT (40%), AL (5%), ZG (15%), and PL (0%) took part in acquisition of data; GDR, (5%), LT (5%), AL (5%), ZG (85%), and PL (0%) analyzed and interpreted the data; and GDR, (5%), LT (5%), AL (5%), ZG (75%), and PL (10%) drafted the article.

Compliance with ethical standards

Conflict of interest

The authors Gayetri Deva Rajoo, Lian Tan, Ainslie Lopez, and Zubin Grover declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Gayetri Deva Rajoo
    • 1
  • Lian Tan
    • 1
  • Ainslie Lopez
    • 1
  • Peter Lewindon
    • 2
  • Zubin Grover
    • 1
    Email author
  1. 1.Gastroenterology DepartmentPrincess Margaret Hospital for ChildrenSubiaco, PerthAustralia
  2. 2.Gastroenterology DepartmentLady Cilento HospitalBrisbaneAustralia

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