Concordance Of PCDAI And CDEIS For Evaluating Activities Of Pediatric Crohn’s Disease

Objective:Crohn’s Disease(CD)is a kind of inflammatory bowel disease and the incidence of pediatric Crohn’s disease increases year by year.Early comprehensive evaluation and examination of pediatric Crohn’s disease could be beneficial to personalized treatment,therapeutic and prognostic evaluation.Crohn’s disease endoscopic index of severity(CDEIS)acts as the best standard to estimate the severity of intestinal inflammation in endoscopy,and recently more scholars and specialists hold the opinion that mucosal remission should be the primary goal of remission induction.But pediatric Crohn’s disease activity index(PCDAI)is still dominant in CD clinical disease activity assessment.Also,laboratory outcomes,such as C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),are reported to correlate with disease activity of CD.It was reported that PCDAI and CDEIS were poorly-related in adult CD patients,but the relationship between laboratory outcomes and disease activity indexes,such as CDEIS and PCDAI,in pediatric CD patients remained obscure.This article discussed the correlation between PCDAI and CDEIS in the first assessment of severity in CD children,and investigated the potential of using clinical classical PCDAI and laboratory examinations to predict the intestinal activity.Methods:We retrospectively analyzed new-diagnosed pediatric CD patients from January,2015 to December,2018 in Children’s Hospital of Zhejiang University School of Medicine.This article recorded patients’ clinical features,laboratory outcomes,PCDAI and CDEIS when they first came to our hospital.There were 2 doctors responsible for careful inquiries and records about detailed history and evaluation of CD using PCDAI.And there was a specialist in gastroenterology responsible for intestinal endoscopic examination and record of the disease in the standardized form.Then scores of CEDIS were analyzed using SPSS 20.0 version.Pearson correlation analysis was applied for correlation of CDEIS,PCDAI and other laboratory examinations(Erythrocyte sedimentation rate,serum albumin,hematocrit,hemoglobin,platelet count,hypersensitive C-reactive protein).Kappa testing was applied for identity of CD severity between PCDAI and colonoscopy,and ROC curve was applied for efficiency analysis among these examinations with CDEIS.Results:The study finally included 37 new onset pediatric CD patients,18 boys and 19 girls,and the average age at diagnosis was 9.5±4.0 years.The mainly clinical features were digestive tract symptom,like stomachache,diarrhea,feeding intolerance,bloody stool and emesis,and there was only a patient without any digestive tract symptom.Fevers were commonly observed(14/37,37.8%),other symptoms,like oral ulcer,perianal abscess and arthritis could also be observed in more than 10%CD children.Strikingly,32 CD children(86.5%)had problems in gaining on weight,while 16 of them(43.2%)fell behind the average height for their age.And Most of endoscopic biopsies reported chronic active inflammation.Typical epithelioid granulomas were totally identified in 37%children(n=14),ulcers were identified in 43.2%(n=16)children and crypt abscess were 24%(n=9).In terms of laboratory examinations,89.2%(n=33)of the patients were reported with thrombocytosis,78.4%(n=29)and 73.0%(n=27)were reported with a rise in ESR and CRP,while 78.4%(n=29)were reported with a decrease in hemoglobin.The mean of CDEIS index was 11.2±7.81 in 37 patients,and the mean of PCDAI was 30.44±12.96.In addition,9 of the patients were reported with an increase in PCDAI,however,no inflammation activities were found in their endoscopy examination.Pearson linear analysis of CDEIS and PCDAI scores in CD pediatric patients showed no significant correlation(r=0.268,P=0.10).Meanwhile,Chi-Square of two indexes was 0.277 in terms of assessment of CD disease activity,which proved that consistence was poor.CDEIS was positively correlated with ESR and CRP,but the correlations were poor(r=0.503,P<0.01;r=0.453,P<0.01).The area under the curve(AUC)of CRP and ESR were 0.772 and 0.721,they indicated good validity for predicting severe disease activity(CDEIS>12)in children.Taken 11.5 mg/L as the cut-off value of CRP and 15 mm/h as the cut-off value of ESR,the sensibility of CRP and ESR were 89.5%and 100.0%,and the specificity were 55.0%and 35.0%Conclusions:This study concluded that there was no correlation between PCDAI and CDEIS in evaluation scores or predicting CD disease activity.Correlation between regular laboratory examinations and CDEIS also was poor,so current laboratory examinations and PCDAI could not replace CDEIS in the evaluation of colonoscopy disease activity in CD children.But serum ESR and CRP indicated good validity in predicting severe disease activity under colonoscopy.