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[Value of different endoscopic scoring methods in assessing disease activity in pediatric Crohn's disease]
Wen Deng1, Zhong-Yue Li1, Bo Liu1
1Department of Gastroenterology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chonging Key Laboratory of Pediatrics, Chongqing 400014, China.
Insights
Endoscopic scoring methods like CDEIS and SES-CD can assess pediatric Crohn's disease (CD) activity, but don't fully align with the Pediatric Crohn's Disease Activity Index (PCDAI). Elevated ESR and CRP levels effectively predict disease activity in children with CD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Accuracy Studies
Context:
- Pediatric Crohn's disease (CD) management requires accurate assessment of disease activity.
- Endoscopic scoring systems are crucial for evaluating disease severity in pediatric CD.
- The correlation between clinical indices and endoscopic findings needs further clarification.
Purpose:
- To evaluate the utility of various endoscopic scoring methods in assessing pediatric CD activity.
- To compare the performance of different endoscopic scores against the Pediatric Crohn's Disease Activity Index (PCDAI).
- To determine the predictive value of laboratory markers for disease activity in pediatric CD.
Summary:
- This study assessed 70 pediatric CD patients, correlating endoscopic scores (CDEIS, SES-CD, Lewis Score, CE-CD) with the PCDAI.
- While endoscopic scores showed moderate correlation with PCDAI, consistency was poor.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) demonstrated strong predictive value for both clinical and endoscopic disease activity.
Impact:
- Provides insights into the limitations of current endoscopic scoring methods for pediatric CD.
- Highlights the importance of ESR and CRP as reliable biomarkers for monitoring disease activity in pediatric CD.
- Informs clinical practice by suggesting complementary use of laboratory markers alongside endoscopic assessments for better disease management.
Objectives:
To explore the value of different endoscopic scoring methods in assessing disease activity in pediatric Crohn's disease (CD).
Methods:
A total of 70 children diagnosed with CD at the Children's Hospital of Chongqing Medical University from January 2018 to January 2023 were included. Clinical disease activity was assessed using the Pediatric Crohn's Disease Activity Index (PCDAI), while different endoscopic scores were assigned based on endoscopic findings. Spearman rank correlation analysis was used to evaluate the correlation between each endoscopic scoring method and PCDAI as well as laboratory indicators. Kappa test was used to assess the consistency between colonoscopy/capsule endoscopy scoring methods and PCDAI in determining CD activity. Receiver operating characteristic curve analysis was performed to assess the diagnostic efficacy of laboratory indicators in predicting endoscopic activity.
Results:
The PCDAI score showed a moderate positive correlation with the scores of Crohn's Disease Endoscopic Index of Severity (CDEIS) (rs=0.696, P<0.01), Simple Endoscopic Score for Crohn's Disease (SES-CD) (rs=0.680, P<0.01), Lewis Score (rs=0.540, P<0.01), and Capsule Endoscopy-Crohn's Disease Index (CE-CD) (rs=0.502, P<0.01). The consistency between all endoscopic scoring methods and PCDAI in determining CD activity was poor (Kappa=0.069-0.226). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hematocrit (HCT), and serum albumin (ALB) levels showed a moderate correlation with the PCDAI score and the scores of colonoscopy scoring methods (CDEIS and SES-CD) (|rs|=0.581-0.725, P<0.01), but a weak correlation with the scores of capsule scoring methods (P<0.05). ESR and CRP had higher area under the curve (AUC) values in predicting disease activity based on PCDAI, CDEIS, SES-CD, and Lewis Score compared to HCT and ALB (P<0.05).
Conclusions:
CDEIS, SES-CD, Lewis Score, and CE-CD can be used to evaluate disease activity in pediatric CD, but they do not fully correspond with disease activity assessed by PCDAI. Elevated levels of ESR and CRP can predict clinical and endoscopic disease activity in children with CD.
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