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PR3-ANCA and panel diagnostics in pediatric inflammatory bowel disease to distinguish ulcerative colitis from Crohn's
Michael P Horn1, Anna Maria Peter2, Franziska Righini Grunder3,4
1University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
Anti-neutrophil cytoplasmic antibodies specific for proteinase-3 (PR3-ANCA) show high specificity for ulcerative colitis (UC). An antibody panel including PR3-ANCA accurately differentiates between UC and Crohn's disease (CD) in pediatric patients.
Area of Science:
- Gastroenterology
- Immunology
- Pediatric Medicine
Background:
- Accurate classification of inflammatory bowel disease (IBD) into ulcerative colitis (UC) and Crohn's disease (CD) is crucial for effective treatment and prognosis.
- Distinguishing between UC and CD remains a diagnostic challenge in clinical practice.
Purpose of the Study:
- To evaluate the diagnostic utility of anti-neutrophil cytoplasmic antibodies specific for proteinase-3 (PR3-ANCA) for identifying UC.
- To assess the effectiveness of an antibody panel, including PR3-ANCA, in differentiating between CD and UC.
Main Methods:
- A retrospective cohort study included 122 pediatric and adolescent individuals (61 IBD patients, 61 controls).
- Comprehensive antibody profiling was performed on stored sera using quasi-exhaustive logistic regression for model determination.
- A training cohort was used to identify the best discriminative model, which was then validated in a separate cohort.
Main Results:
- PR3-ANCA demonstrated significant specificity for UC (odds ratio = 17.6; P < .001).
- A four-antibody panel incorporating PR3-ANCA achieved an AUC of 90.81% for distinguishing UC from CD in the training cohort.
- The panel showed an AUC of 84.13% in an external validation cohort for accurate CD and UC diagnosis.
Conclusions:
- PR3-ANCA is a highly specific biomarker for ulcerative colitis.
- An antibody panel combining PR3-ANCA with other broadly available antibodies offers superior diagnostic capability.
- This panel can aid in the accurate classification of pediatric and adolescent IBD patients.
Background:
Accurate classification of patients with inflammatory bowel disease into the subtypes ulcerative colitis (UC) and Crohn's disease (CD) is still a challenge, but important for therapy and prognosis.
Objectives:
To evaluate the diagnostic utility of anti-neutrophil cytoplasmic antibodies specific for proteinase-3 (PR3-ANCA) for ulcerative colitis (UC) and the value of an antibody panel incorporating PR3-ANCA to differentiate between Crohn's disease (CD) and UC.
Study Design:
In this cohort study, 122 pediatric and adolescent individuals were retrospectively included (61 IBD patients of two clinical centers, 61 non-IBD controls). All subjects had a comprehensive antibody profile done from stored sera taken close to time of diagnosis. By employing quasi-exhaustive logistic regression the best discriminative model for UC and CD,subjects was determined in a training cohort and confirmed in a validation cohort.
Results:
PR3-ANCA was specifically associated with UC (odds ratio (OR), 17.6; 95% confidence interval (CI); 3.6, 87); P < .001). A four antibody-panel including PR3-ANCA had an AUC of 90.81% (95%CI; 81.93, 99.69) to distinguish between UC and CD in the training cohort. In a smaller external validation cohort, the AUC was 84.13% (95%CI; 64.21, 100) for accurate diagnosis of CD and UC.
Conclusion:
PR3-ANCA is highly specific for UC. The differentiating capability of a panel, which contains PR3-ANCA and weighs broadly available antibodies, is superior and utilization of the panel can support accurate classification in the work-up of pediatric and adolescent patients with IBD patients.
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