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C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) or both? A systematic evaluation in pediatric
Dan Turner1, David R Mack, Jeffrey Hyams
1Pediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel. turnerd@szmc.org.il
Insights
In pediatric ulcerative colitis (UC), both C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can monitor disease activity. While CRP shows a slight superiority and better correlation with endoscopic findings, routine testing of both may not be necessary.
Area of Science:
- Pediatric Gastroenterology
- Clinical Chemistry
- Inflammatory Bowel Disease Research
Background:
- Limited comparative studies exist on C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for monitoring ulcerative colitis (UC) activity.
- Understanding the utility of these biomarkers is crucial for effective pediatric UC management.
Purpose of the Study:
- To extensively compare the diagnostic and monitoring utility of CRP and ESR in pediatric patients with ulcerative colitis (UC).
- To determine the correlation of CRP and ESR with endoscopic disease activity and clinical assessments.
Main Methods:
- Analysis of laboratory, clinical, and endoscopic data from 451 children with UC across four cohorts.
- Longitudinal analysis of prospectively collected data from 75 children.
- Disease activity assessed using global assessment and the pediatric UC activity index (PUCAI).
Main Results:
- Optimal thresholds for differentiating UC disease activity were established for both ESR and CRP.
- CRP demonstrated a stronger correlation with endoscopic appearance (0.55) compared to ESR (0.41).
- Discordant results between CRP and ESR were observed in a significant proportion of patients across different disease activity levels.
Conclusions:
- Both CRP and ESR reflect disease activity similarly in approximately two-thirds of pediatric UC patients.
- CRP may offer a slight advantage and is more closely linked to endoscopic findings.
- Routine testing of both CRP and ESR for monitoring UC disease activity may not be consistently justified.
Background:
There has not been an extensive comparison of CRP and ESR in ulcerative colitis (UC), and thus, we aimed to explore their utility in UC.
Methods:
Four previously enrolled cohorts of 451 children with UC were utilized, all including laboratory, clinical and endoscopic data. A longitudinal analysis was performed on prospectively collected data of 75 children. Disease activity was captured by both global assessment and pediatric UC activity index (PUCAI).
Results:
The best thresholds to differentiate quiescent, mild, moderate and severe disease activity, were <23, 23-29, 30-37, >37 mm/h for ESR, and <2.5, 2.5-5, 5.01-9, >9 mg/L for CRP (area under the ROC curves 0.70-0.81). Correlation of endoscopic appearance with CRP and ESR were 0.55 and 0.41, respectively (P<0.001). Both CRP and ESR may be completely normal in 34% and 5-10% of those with mild and moderate-severe disease activity, respectively. Elevated CRP in the presence of normal ESR or vice versa was noted in 32%, 38%, 30% and 17% of those with quiescent, mild, moderate and severe disease activity. Over time, the utility of CRP and ESR in reflecting disease activity remained stable in 70-80% of cases.
Conclusion:
In ~2/3 of children, both CRP and ESR values reflect disease activity to a similar degree and in the remaining, either CRP or ESR may be sufficient, with slight superiority of CRP. CRP is more closely correlated with endoscopic appearance. When either CRP or ESR performs well for a given patient, this is likely to remain so over time. Therefore, it may not be justified to routinely test both ESR and CRP in monitoring disease activity.
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