Supplementary Material for: Impact of Diagnostic Delay on Disease Course in Pediatric Versus Adult-onset Patients with Ulcerative Colitis: Data from the Swiss IBD Cohort

Introduction: Given the lack of data we aimed to assess the impact of the length of diagnostic delay on natural history of ulcerative colitis in pediatric (diagnosed &lt;18 years) and adult patients (diagnosed ≥18 years). Methods: Data from the Swiss Inflammatory Bowel Disease cohort study were analyzed. Diagnostic delay was defined as interval between the first appearance of UC-related symptoms until diagnosis. Logistic regression modeling evaluated the appearance of the following complications in the long term according to the length of diagnostic delay: colonic dysplasia, colorectal cancer, UC-related hospitalization, colectomy, and extra-intestinal manifestations (EIM). Results: A total of 184 pediatric and 846 adult patients were included. Median diagnostic delay was 4 [IQR 2-7.5] months for the pediatric-onset group and 3 [IQR 2-10] months for the adult-onset group (P=0.873). In both, pediatric and adult-onset groups, length of diagnostic delay at UC diagnosis was not associated with colectomy, UC-related hospitalization, colon dysplasia, and colorectal cancer. EIM were significantly more prevalent at UC diagnosis in the adult-onset group with long diagnostic delay compared to the adult-onset group with short diagnostic delay (p = 0.022). In the long term, length of diagnostic delay was associated in the adult onset group with colorectal dysplasia (p=0.023), EIMs (p&lt;0.001) and more specifically arthritis/arthralgias (p&lt;0.001) and ankylosing spondylitis/sacroiliitis (p&lt;0.001). In the pediatric-onset UC group, length of diagnostic delay in the long term was associated with arthritis/arthralgias (p=0.017); however, it was not predictive for colectomy and UC-related hospitalization. Conclusions: As colorectal cancer and EIMs are associated with considerable morbidity and costs, every effort should be made to reduce diagnostic delay in UC patients.引言：鉴于现有数据的匮乏，本研究旨在评估诊断延误时长对儿童（确诊年龄<18岁）及成人（确诊年龄≥18岁）溃疡性结肠炎（Ulcerative Colitis, UC）自然病程的影响。 方法：本研究分析了瑞士炎症性肠病队列研究（Swiss Inflammatory Bowel Disease Cohort Study）的数据。诊断延误定义为溃疡性结肠炎相关症状首次出现至确诊的时间间隔。采用Logistic回归（Logistic Regression）模型，依据诊断延误时长分析长期随访中以下并发症的发生情况：结肠上皮异型增生、结直肠癌、UC相关住院、结肠切除术及肠外表现（Extra-Intestinal Manifestations, EIM）。 结果：共纳入184例儿童发病患者及846例成人发病患者。儿童发病组的诊断延误中位时长为4个月[四分位间距（Interquartile Range, IQR）2~7.5个月]，成人发病组为3个月[IQR 2~10个月]（P=0.873）。儿童及成人发病组中，UC确诊时的诊断延误时长均与结肠切除术、UC相关住院、结肠上皮异型增生及结直肠癌无显著关联。成人发病组中，诊断延误时长较长的患者在UC确诊时的肠外表现患病率显著高于诊断延误时长较短的患者（P=0.022）。长期随访中，成人发病组的诊断延误时长与结肠上皮异型增生（P=0.023）、肠外表现（P<0.001）——尤其是关节炎/关节痛（P<0.001）及强直性脊柱炎/骶髂关节炎（P<0.001）——显著相关。儿童发病组UC患者中，长期随访的诊断延误时长仅与关节炎/关节痛相关（P=0.017），但无法预测结肠切除术及UC相关住院的发生。 结论：鉴于结直肠癌及肠外表现会带来显著的发病率与医疗成本，应尽一切努力缩短UC患者的诊断延误时长。