Utility of Serological Markers in Predicting the Early Occurrence of Complications and Surgery in Pediatric Crohn's Disease Patients

Devendra K. Amre, Shou En Lu, Florin Costea, Ernest G. Seidman

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: Many Crohn's disease (CD) patients develop complications (fistulae and abscesses), and require surgery, often repeatedly and at variable instances. Identifying serological markers that determine their early or repeated manifestation can enable implementing more aggressive preventive strategies. Our objective was to study the ability of serological markers for predicting development of early (first) and recurrent complications or requirement for surgery. METHODS: Serum anti-Saccharomyces cervisiae (ASCA) (IgA & IgG) and perinuclear antineutrophil cytoplasmic antibodies (pANCA) were assayed close to diagnosis in a pediatric cohort of CD patients identified between 1996 and 1998. At diagnosis and follow-up, information was acquired on demographic and clinical features of disease. Relation between ASCA and clinical events was studied using adjusted Cox-proportional hazards modeling. The relative rates of recurrent clinical events according to the marker measures were compared. RESULTS: The mean age (SD) at diagnosis was 11.2 (3.4) yr. Among 139 patients, 35 (25.9%) and 31 (22.3%) acquired one or more CD related surgery or complication, respectively. Time to occurrence of the first complication was lower among patients ASCA+ (IgA or IgG) (hazards ratio (HR) = 2.33; 95% confidence interval (CI) = 0.99-5.50) and among those with higher ASCA-IgA titers (HR = 1.20; 95% CI = 1.08-1.34). The rates of recurrent complications were higher among those positive or with higher ASCA titers. ASCA did not predict time to undergoing surgery independent of complications, and was unrelated to the occurrence of recurrent surgeries. CONCLUSIONS: Our study shows that serum ASCA measured close to diagnosis can determine the occurrence of early complications in pediatric CD. Preventive treatment targeted toward these susceptible patients could potentially modify the disease course.

Original languageEnglish (US)
Pages (from-to)645-652
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume101
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

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Saccharomyces
Immunoglobulin A
Crohn Disease
Immunoglobulin G
Confidence Intervals
Antineutrophil Cytoplasmic Antibodies
Pediatric Crohn's disease
Serum
Abscess
Fistula
Demography

ASJC Scopus subject areas

  • Gastroenterology

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Utility of Serological Markers in Predicting the Early Occurrence of Complications and Surgery in Pediatric Crohn's Disease Patients. / Amre, Devendra K.; Lu, Shou En; Costea, Florin; Seidman, Ernest G.

In: American Journal of Gastroenterology, Vol. 101, No. 3, 03.2006, p. 645-652.

Research output: Contribution to journalArticle

Amre, Devendra K. ; Lu, Shou En ; Costea, Florin ; Seidman, Ernest G. / Utility of Serological Markers in Predicting the Early Occurrence of Complications and Surgery in Pediatric Crohn's Disease Patients. In: American Journal of Gastroenterology. 2006 ; Vol. 101, No. 3. pp. 645-652.
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AB - BACKGROUND AND OBJECTIVES: Many Crohn's disease (CD) patients develop complications (fistulae and abscesses), and require surgery, often repeatedly and at variable instances. Identifying serological markers that determine their early or repeated manifestation can enable implementing more aggressive preventive strategies. Our objective was to study the ability of serological markers for predicting development of early (first) and recurrent complications or requirement for surgery. METHODS: Serum anti-Saccharomyces cervisiae (ASCA) (IgA & IgG) and perinuclear antineutrophil cytoplasmic antibodies (pANCA) were assayed close to diagnosis in a pediatric cohort of CD patients identified between 1996 and 1998. At diagnosis and follow-up, information was acquired on demographic and clinical features of disease. Relation between ASCA and clinical events was studied using adjusted Cox-proportional hazards modeling. The relative rates of recurrent clinical events according to the marker measures were compared. RESULTS: The mean age (SD) at diagnosis was 11.2 (3.4) yr. Among 139 patients, 35 (25.9%) and 31 (22.3%) acquired one or more CD related surgery or complication, respectively. Time to occurrence of the first complication was lower among patients ASCA+ (IgA or IgG) (hazards ratio (HR) = 2.33; 95% confidence interval (CI) = 0.99-5.50) and among those with higher ASCA-IgA titers (HR = 1.20; 95% CI = 1.08-1.34). The rates of recurrent complications were higher among those positive or with higher ASCA titers. ASCA did not predict time to undergoing surgery independent of complications, and was unrelated to the occurrence of recurrent surgeries. CONCLUSIONS: Our study shows that serum ASCA measured close to diagnosis can determine the occurrence of early complications in pediatric CD. Preventive treatment targeted toward these susceptible patients could potentially modify the disease course.

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