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C-Reactive Protein/Albumin Ratio at Diagnosis of Pediatric Inflammatory Bowel Disease: A Retrospective Multi-Center
Aleksandra Glapa-Nowak1, Mariusz Szczepanik1, Aleksandra Banaszkiewicz2
1Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, Poznań, Poland.
Insights
The C-reactive protein-to-albumin (CRP/albumin) ratio can help identify severe pediatric Crohn
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Inflammatory Bowel Disease (IBD) Research
- Biomarker Discovery in Pediatrics
Background:
- Inflammatory Bowel Disease (IBD) encompasses Crohn's disease (CD) and ulcerative colitis (UC), chronic conditions affecting the gastrointestinal tract.
- Accurate disease assessment and prediction of disease course in pediatric IBD are crucial for effective management.
- The C-reactive protein-to-albumin (CRP/albumin) ratio is a potential biomarker reflecting inflammation and nutritional status.
Purpose of the Study:
- To evaluate the diagnostic utility of the CRP/albumin ratio in pediatric patients with newly diagnosed IBD.
- To assess the association between the CRP/albumin ratio and disease severity, behavior, and treatment needs in pediatric CD and UC.
- To explore the correlation of the CRP/albumin ratio with clinical outcomes and disease activity indices.
Main Methods:
- A cohort study involving 345 pediatric patients (aged 3-18 years) diagnosed with CD (n=186) or UC (n=159).
- Serum CRP/albumin ratio was calculated at diagnosis for all participants.
- Statistical analyses, including area under the curve (AUC) and odds ratios (OR), were used to assess the ratio's discriminatory power for disease severity, behavior, and treatment requirements.
Main Results:
- The CRP/albumin ratio at diagnosis differed significantly among disease severity groups in pediatric CD (P=0.011).
- The ratio effectively differentiated severe CD from quiescent CD (AUC=0.94) and moderately differentiated penetrating from non-penetrating CD behavior (AUC=0.73).
- The CRP/albumin ratio showed weak differentiation for the need for biological treatment (AUC=0.58) and surgery (AUC=0.63) in IBD patients.
Conclusions:
- The CRP/albumin ratio at diagnosis is a valuable tool for differentiating disease severity and behavior in pediatric Crohn's disease.
- While not significantly associated with the overall disease course in pediatric CD or UC, it aids in identifying severe cases.
- These findings support the use of the CRP/albumin ratio as a readily available biomarker in the initial assessment of pediatric IBD.
Abstract:
BACKGROUND This study aimed to evaluate the C-reactive protein-to-albumin (CRP/albumin) ratio at diagnosis of pediatric inflammatory bowel disease (IBD). MATERIAL AND METHODS Serum CRP/albumin ratio was calculated for patients with Crohn's disease (CD; n=186) and ulcerative colitis (UC; n=159) aged 3-18 years. RESULTS Patients with CD differed in CRP/albumin ratio at diagnosis in groups with quiescent, mild, moderate, and severe disease (P=0.011). CRP/albumin ratio at diagnosis was significant in differentiating patients with severe CD from quiescent disease at diagnosis (area under the curve (AUC)=0.94, odds ratio (OR)=63.4, 95% confidence interval (CI) 7.1-569.1, P<0.0001). CRP/albumin ratio at diagnosis could moderately differentiate penetrating from non-penetrating disease behavior in CD at diagnosis (AUC=0.73, OR=6.3, 95% CI 2.0-19.3, P<0.001). Furthermore, CRP/albumin ratio at diagnosis weakly differentiated IBD patients in need of biological treatment in a step-up procedure (AUC=0.58, OR=2.1, 95% CI 1.3-3.4, P=0.022) and in need of surgery (AUC=0.63, OR=3.1, 95% CI 1.4-7.2, P=0.006). For the IBD, CRP/albumin ratio at diagnosis was weakly correlated with age at first immunosuppressive treatment (rho=0.20, P=0.018), time from diagnosis to first biological treatment (rho=-0.37, P<0.001), days spent in hospital (rho=0.26, P=0.007), number of severe relapses (rho=0.31, P=0.001), and Pediatric Crohn's Disease Activity Index (rho=0.38, P=0.002). CONCLUSIONS The present findings add to previous studies carried out in adult patients and show that the CRP/albumin ratio at diagnosis was not significantly associated with the course of either CD or UC in children. However, CRP/albumin ratio could differentiate patients with severe CD from those with quiescent disease.
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