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Shortcomings of the inflammatory bowel disease Serology 7 panel
Shira Benor1, George H Russell, Michael Silver
1Department of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Hardvard University, Boston, MA, USA. shirabenor@yahoo.com
Insights
The Prometheus Inflammatory Bowel Disease (IBD) Serology 7 (IBD7) panel showed lower predictive values than routine blood tests for diagnosing pediatric IBD. Routine tests are more effective for initial screening in children with suspected IBD.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Diagnostic Accuracy
Background:
- Inflammatory Bowel Disease (IBD) diagnosis in children requires accurate and timely screening.
- Serological panels, like the Prometheus IBD Serology 7 (IBD7) panel, are increasingly used for IBD evaluation.
- Comparing novel serological tests with established routine laboratory markers is crucial for clinical utility.
Purpose of the Study:
- To compare the predictive values of the IBD7 panel against routine blood tests for pediatric IBD diagnosis.
- To assess the diagnostic performance of the IBD7 panel in children with suspected IBD.
Main Methods:
- Retrospective review of medical records of pediatric patients evaluated for IBD.
- Analysis of diagnostic data including clinical, radiologic, endoscopic, and pathologic findings.
- Comparison of sensitivity, specificity, and predictive values between the IBD7 panel and routine laboratory tests.
Main Results:
- The IBD7 panel demonstrated lower sensitivity (67%) and specificity (76%) compared to routine tests (72% and 94%).
- Positive predictive value for IBD7 was 63% versus 85% for routine tests.
- The antiflagellin antibody assay, a component of IBD7, showed poor performance (50% sensitivity, 53% specificity), and repeat testing yielded inconsistent results.
Conclusions:
- The IBD7 panel exhibits lower predictive values than routine laboratory tests for pediatric IBD screening.
- Routine blood tests appear more effective for initial diagnostic evaluation of suspected IBD in children.
- Further validation and refinement of serological panels are needed for improved pediatric IBD diagnostics.
Objective:
The goal was to compare the predictive values of the Prometheus Inflammatory Bowel Disease (IBD) Serology 7 (IBD7) panel (Prometheus Laboratories, San Diego, CA) with the predictive values of routine blood tests in a population of children referred for initial evaluation of suspected IBD.
Methods:
Medical records of pediatric patients referred for evaluation of IBD for whom IBD7 testing was performed at Prometheus Laboratories between January 2006 and November 2008 were reviewed. Patients underwent diagnosis by pediatric gastroenterologists on the basis of clinical, radiologic, endoscopic, and pathologic evaluations.
Results:
A total of 394 records were identified. We excluded 90 records on the basis of age of >21 years, previous diagnosis of IBD, or unclear diagnosis. The prevalence of IBD in this cohort was 38%. The sensitivity, specificity, positive predictive value, negative predictive value, and kappa value for the serological panel were 67%, 76%, 63%, 79%, and 42%, respectively, compared with values for a combination of 3 abnormal routine laboratory test results of 72%, 94%, 85%, 79%, and 47%. The antiflagellin antibody assay, the newest assay added to the panel, had sensitivity of 50% and specificity of 53%. Repeat serological testing failed to produce consistent results for 4 of 10 patients.
Conclusion:
Despite its recent inclusion of the antiflagellin assay, the IBD7 panel has lower predictive values than routine laboratory tests in pediatric screening for IBD.
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