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Non-invasive Index Effectively Monitors Mucosal Healing in Pediatric Crohn's
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Researchers developed a non-invasive index score to help assess mucosal healing in children with Crohn’s disease.
Maarten Cozijnsen, MD, of Erasmus MC-Sophia Children’s Hospital in the Netherlands, and colleagues wrote that mucosal healing has been a helpful target to help guide the treatment of CD, but it has limitations, particularly among children.
“Mucosal healing has become a therapeutic goal in CD, but frequent endoscopies in children are not feasible,” Cozijnsen told Healio Gastroenterology and Liver Disease. “We developed an index, based on factors that can be measured non-invasively, that can accurately distinguish children with CD and significant inflammation from those with mucosal healing.”
Investigators built their index — known as Mucosal-Inflammation Non-Invasive, or MINI — by collecting data from the multi-center prospective ImageKids study, where pediatric patients with CD underwent ileocolonoscopy with magnetic resonance enterography. They looked for links between the pediatric CD activity index (PCDAI) items and laboratory test results — serum biochemical tests and fecal calprotectin — with the simple endoscopic score for CD (SESCD).
Cozijnsen and colleagues used these data to develop a weighted categorized index, which they tested in a derivation cohort (n = 154) and three independent validation cohorts (n = 168).
In their analysis, researchers found that the stooling item from the PCDAI, erythrocyte sedimentation rate and level of fecal calprotectin were associated with SESCD score (P < .05). They used these measures, as well as C-reactive protein levels to develop their new index.
MINI scores below 8 identified children with mucosal healing with 88% sensitivity and 85% specificity in the derivation cohort and with 84% sensitivity and 87% specificity in the validation cohorts.
Among patients in the validation cohort, 90% of those with MINI scores of at least 8 had active inflammation, while 78% of patients with scores lower than 8 had mucosal healing. Scores lower than 6 increased the positive predictive value to 86%.
“This index can be used in clinical practice to assess response to therapy and facilitate selection of patients for ileocolonoscopy,” Cozijnsen said in an email. “It may also be considered for use in clinical trials, instead of or in addition to ileocolonoscopy.” – by Alex Young
Disclosures: Cozijnsen reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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