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Peripheral Blood Monocytosis Is Associated With Long-Term Disease Severity in Pediatric-Onset Inflammatory Bowel
Xiaoyi Zhang1, Claudia Ramos-Rivers2, Krishnapriya Prathapan3
1From the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Indiana University, Riley Hospital for Children, Indianapolis, IN.
Insights
Peripheral blood monocytosis (PBM) in pediatric-onset inflammatory bowel disease (IBD) indicates a more severe long-term disease course. Patients with PBM experienced worse outcomes, including increased healthcare utilization and need for biologic therapies.
Area of Science:
- Gastroenterology
- Immunology
- Hematology
Background:
- Peripheral blood monocytosis (PBM) is linked to increased disease severity in adult inflammatory bowel diseases (IBD).
- The prognostic value of PBM in pediatric-onset IBD (pIBD) followed into adulthood is not well-established.
Purpose of the Study:
- To investigate if PBM in pediatric-onset IBD patients predicts a more aggressive long-term disease course into adulthood.
- To identify clinical outcomes associated with PBM in this cohort.
Main Methods:
- Retrospective analysis of 581 pediatric-onset IBD patients (2009-2019) from a tertiary care center registry.
- Comparison of clinical trajectories between patients with and without PBM, defined by elevated monocyte counts at any time.
- Multivariate logistic regression to assess associations with steroid/biologic use, surgeries, and healthcare utilization.
Main Results:
- Monocytosis was detected in 40.1% of the 581 pediatric-onset IBD patients (440 Crohn disease, 141 ulcerative colitis).
- PBM correlated with steroid/biologic exposure, surgeries, and increased healthcare utilization.
- Multivariate analysis revealed PBM was associated with higher odds of biologic use, emergency visits, and hospitalizations, but not surgeries.
Conclusions:
- Peripheral blood monocytosis in pediatric-onset IBD is a significant biomarker for worse clinical outcomes.
- PBM is associated with increased disease severity and healthcare utilization in patients followed into adulthood.
- PBM may guide more intensive monitoring and treatment strategies for pediatric IBD patients.
Objectives:
Peripheral blood monocytosis (PBM) is a marker of increased disease severity in adults with inflammatory bowel diseases (IBDs). We sought to determine whether PBM serves as a prognostic biomarker in patients with pediatric-onset IBD for a more aggressive long-term disease course when followed into adulthood.
Methods:
Patients with pediatric-onset inflammatory bowel disease were identified within an adult tertiary care center, within a consented, prospectively collected natural history disease registry, to compare clinical outcomes between patients with and without PBM from the years 2009 to 2019. Patients demonstrating elevation in PBM at any time defined membership and long-term clinical trajectories were compared with pediatric-onset patients without PBM.
Results:
A total of 581 patients with IBD, diagnosed by 18 years of age, were identified for inclusion, of which 440 patients were diagnosed with Crohn disease and 141 with ulcerative colitis. Monocytosis was detected by complete blood cell counts in 40.1% of patients. PBM was associated with steroid and biologic exposure, number of IBD-related surgeries, and increased health care utilization. Multivariate logistic regression analyses, accounting for elevation of inflammatory markers and other values associated with acute disease activity as well as steroid use, showed persistently increased odds of biologic exposure, emergency department visits, and hospitalizations, but not surgeries, after detection of monocytosis.
Conclusions:
Within patients with pediatric-onset IBD, the sub-cohort with PBM had associated worse clinical outcomes and other markers of increased disease severity.
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