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Published on: February 10, 2017
Post-stem cell transplantation pediatric gastrointestinal graft-versus-host disease: nomogram analysis of clinical
Jingqing Zeng1, Ruotong Yin1, Lan Wang1
1Digestive Department of Pediatrics, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Background:
Gastrointestinal graft-versus-host disease (GI-GVHD) is diagnosed via histological examination of endoscopic mucosal biopsy specimens; however, the optimal endoscopic diagnostic strategy remains unclear. This study aimed to identify key clinical symptoms, gastrointestinal sites, and endoscopic approaches for diagnosing pediatric GI-GVHD.
Methods:
A retrospective analysis of post-bone marrow stem cell transplant patients with gastrointestinal symptoms at Shanghai Children's Medical Center (2018-2023) was conducted. A nomogram prediction model was developed using univariate and multivariate logistic regression analyses based on clinical, endoscopic, and histopathological characteristics.
Results:
Among 63 patients (29 GI-GVHD, 34 non-GI-GVHD), GI-GVHD was associated with skin rejection (P = 0.002), diarrhea (P = 0.07), and bloody stools (P = 0.009). C-reactive protein (CRP) > 30 mg/L and mucosal ulcers were more common in the non-GI-GVHD group than the GI-GVHD group (P = 0.016, P = 0.029). Independent GI-GVHD indicators included skin rejection (P = 0.035), apoptotic corpuscles (P = 0.030), mucosal edema (P = 0.007), and tortoise shell-like mucosa (P = 0.020). Transverse colonic mucosal edema (76.2%) and tortoise shell-like mucosa (74.6%) demonstrated the highest diagnostic accuracy in the nomogram.
Conclusions:
Gastroscopy combined with colonoscopy is recommended for diagnosing GI-GVHD. The key diagnostic indicators include skin rejection, mucosal edema, tortoise shell-like mucosa, and apoptotic corpuscles. Our nomogram aids in GI-GVHD diagnosis.
Impact:
Our study identified key clinical, endoscopic, and histopathological markers for pediatric gastrointestinal graft-versus-host disease (GI-GVHD), emphasizing colonic mucosal edema and tortoise shell-like mucosa as GI-GVHD indicators. Our results underscore the value of combining gastroscopy and colonoscopy while introducing a predictive nomogram for risk assessment. These findings can enhance early and accurate diagnosis, enabling timely, targeted interventions to improve patient outcomes.
