Predicting endoscopic Crohn's disease activity before and after induction therapy in children: A comprehensive assessment of PCDAI, CRP, and fecal calprotectin

Zubin, Grover and Peter, Lewindon (2015) Predicting endoscopic Crohn's disease activity before and after induction therapy in children: A comprehensive assessment of PCDAI, CRP, and fecal calprotectin. Inflammatory Bowel Diseases, 21 6: 1386-1391. doi:10.1097/MIB.0000000000000388


Author Zubin, Grover
Peter, Lewindon
Title Predicting endoscopic Crohn's disease activity before and after induction therapy in children: A comprehensive assessment of PCDAI, CRP, and fecal calprotectin
Journal name Inflammatory Bowel Diseases   Check publisher's open access policy
ISSN 1536-4844
1078-0998
Publication date 2015-04-03
Sub-type Article (original research)
DOI 10.1097/MIB.0000000000000388
Open Access Status Not yet assessed
Volume 21
Issue 6
Start page 1386
End page 1391
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams and Wilkins
Collection year 2016
Language eng
Formatted abstract
Background: Mucosal healing (MH) is a vital early endpoint in management of Crohn’s disease (CD). MH depends on endoscopic assessment and there is increasing interest in non-invasive proxies, Pediatric Crohn’s Disease activity Index (PDCAI), C-reactive protein (CRP) and fecal calprotectin (FC). These proxies must be validated against endoscopic disease activity (SES-CD) at diagnosis and after induction therapy in well characterized cohorts of children with CD.

Methods: A prospective cohort of 24 newly diagnosed children (<16 yr) with luminal CD quantifiable on complete ileo-colonoscopy had paired PCDAI, CRP, FC and SES-CD at diagnosis and after 8 weeks therapy with exclusive enteral nutrition or steroids.

Results: At diagnosis: PCDAI had poor correlation (r = 0.33); CRP (r = 0.54) and FC (r = 0.46) had moderate correlation with SES-CD. After induction therapy: 11/24 had inactive disease (SES-CD 0-2); PCDAI (r = 0.34) and CRP (0.28) had poor correlation with SES-CD, many children with SES-CD >=3 having normalization of both PCDAI and CRP. FC had good correlation (r = 0.50) but many with SES-CD 0-2 had FC >200 µg/gm stool. FC<500 (positive likelihood ratio, 3.2) and FC drop >50% (positive likelihood ratio, 3.8) had greater predictive value for inactive disease. Composite PCDAI (<10), CRP (<5 mg/dl) & FC <500 µg had excellent Negative LR (0.2) predicting inactive disease.

Conclusions: PCDAI is unreliable for endoscopic disease severity assessment. Only FC correlates with endoscopic activity after therapy but cut off <200 µg is too high for defining endoscopic recovery in children. Composite normalized PCDAI, CRP and FC <500 µg should be considered the non-invasive endpoint for treatment response in pediatric CD.
Keyword C-reactive protein
Calprotectin
Crohn's disease
Endoscopy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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