Ibrahim DOGAN, Mehmet IBİS, Ibrahim Koral ONAL, Mehmet ARHAN, Nasser ALİZADEH, Zeynep Gok SARGİN

Role of Inflammatory Markers as Predictors of Clinical Activity and Endoscopic Severity in Crohn's Disease

Amaç: Crohn hastalığında (CH) klinik aktivite ve endoskopik tutulum ciddiyetinin değerlendirmeyi amaçladık Gereç ve Yöntem: Bilinen veya olası CH tanısı ile kolonoskopi yapılan hastalar çalışmaya alındı. Klinik hastalık aktivitesi Crohn Hastalığı Aktivite İndeksi (CHAİ) üzerinden hesaplanarak endoskopik aktivite de CH için basit endoskopik skor (BES) kullanılarak kaydedildi. İşlem karakteristik eğri (İKE) analizi ile inflamatuar göstergeçlerin prediktif değerleri saptandı. Bulgular: Şu parametreler aktif ve remisyondaki Crohn hastaları arasında anlamlı olarak farklıydı: BES, C-reaktif protein (CRP) beyaz küre sayısı, nötrofil sayısı, hemoglobin, trombosit sayısı, albümin ve fekal kalprotektin (FK). Şu parametreler hafif (BES=7) endoskopik aktivite gösteren Crohn hastaları arasında anlamlı olarak farklıydı: CHAİ, beyaz küre sayısı, CRP, nötrofil sayısı, albümin ve FK. Crohn hastalarında orta-ciddi endoskopik aktivitenin saptanmasındaki CRP cutt-off değeri İKE analizi kullanıldığında >=11.5 mg/L olarak hesaplanırken [Sensitivite: %70, spesifisite: %100, AUC: 0.790 (0.567-1.013), P=0.028] bu değer FK için 487 µg/g'dı [Sensitivite: %70, spesifisite: %90, AUC: 0.805 (0.598-1.01), P=0.028]. FC > 487 µg/g ve CRP>11.5 mg/L olan 6 hastanın hepsinde de orta-ciddi endoskopik aktivite saptandı. Sonuçlar: CRP veya FK nin artmış konsantrasyonları klinik ve endoskopik hastalık aktivitesi açısından tahmin edicidir.

Crohn Hastalığında Klinik Aktivite ve Endoskopik Tutulum Ciddiyetinin Prediktörleri Olarak İnflamatuarGöstergeçlerin Rolü

Objective: We aim to assess the role of inflammatory markers as predictors of clinical activity and endoscopic severity in Crohn's disease (CD). Methods: Patients attending for colonoscopy with known or suspected CD were recruited. Clinical disease activity was recorded as per the Crohn's Disease Activity Index (CDAI) and endoscopic activity was recorded using the simple endoscopic score (SES) for CD. Receiver operating characteristic analysis (ROC) determined the predictive value and optimal predictive thresholds for the inflammatory markers. Results: The folllowing parameters were significantly different between clinically active CD and CD in remission: SES, C-reactive protein (CRP), white blood cell count (WBC), neutrophil count, hemoglobin, platelet count, albumin and fecal calprotectin (FC). And the following parameters were significantly different between patients with mild (SES=7) endoscopic activity: CDAI, WBC, CRP, neutrophil count, albumin and FC. The cut-off value for CRP for the detection of moderate to severe endoscopic activity in CD patients was calculated as >=11.5 mg/L using ROC analysis [Sensitivity: 70%, specificity: 100%, AUC: 0.790 (0.567-1.013), P=0.028] whereas this cut-off value was 487 µg/g for FC [Sensitivity: 70%, specificity: 90%, AUC: 0.805 (0.598-1.01), P=0.028]. All of the 6 patients with FC >487 µg/g and CRP>11.5 mg/L were found to have moderate to severe endoscopic activity. Conclusion: Increased concentrations of either CRP or FC are predictive of clinical and endoscopic disease activity.

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