A prospective study examining non-invasive proxies in predicting endoscopic disease activity in paediatric Crohn's disease

Abstract

Objectives and Study: Inclusion of surrogate markers such as serum CRP and faecal calprotectin (FC) with Paediatric Crohn's disease activity index (PCDAI) improves prediction of endoscopic activity in Crohn's disease(CD). A recently validated mucosal inflammation non-invasive index (MINI) score utilising stool frequency, CRP/ESR and FC demonstrated 87% specificity and 84% sensitivity in predicting mucosal healing in CD. 1 We aimed to validate MINI-index in our prospective cohort study. Methods: In this prospective observational cohort study (ACTRN1261800074120) , children (< 17 years) with complete Ileo-colonoscopy at diagnosis or during follow up with paired PCDAI, CRP/ESR and FC within two weeks , were recruited from two participating children's hospital. Endoscopy scores were measured using Simple Endoscopic Score (SES-CD) score, remission was defined as SES-CD (0-3), mild activity (4-10) and moderate-severe activity >10.Endoscopic video were evaluated by an independent blinded review. Results: A total of 70 children were recruited, 14 were excluded (3 with extensive proximal small bowel CD, 6 with incomplete colonoscopy, 5 FC not available < 2 weeks). Of 56 (34 males) included (n=17 had SES-CD 0-3), n=16 (SES-CD 4-10), n=23 (SES-CD >10). Mean(SD) SES-CD scores were 8.8 ± 8.3. Mini-index< 8 has sensitivity of 70% and specificity 90% in predicting endoscopic remission (SES-CD,0-3). Conclusions: In our prospective validation study, we report marginally higher sensitivity of MINI < 8 over FC cut off 300μg/g in predicting endoscopic remission. While our results suggest a high negative predictive value but a lower positive predictive value compared to recently published validation study. Further data is required before we use Mini-index to modify our treatment decisions. (Table Presented).L6295850622019-10-21 <br />