Open AccessAnalysis of Using the Total White Blood Cell Count to Define Severe New‐onset Ulcerative Colitis in Children
Author(s) -
Mack David R.,
Saul Bradley,
Boyle Brendan,
Griffiths Anne,
Sauer Cary,
Markowitz James,
LeLeiko Neal,
Keljo David,
Rosh Joel R.,
Baker Susan S.,
Steiner Steve,
Heyman Melvin B.,
Patel Ashish S.,
Baldassano Robert,
Noe Joshua,
Rufo Paul,
Kugathasan Subra,
Walters Thomas,
Marquis Alison,
Thomas Sonia M.,
Denson Lee,
Hyams Jeffrey
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002797
Subject(s) - medicine , ulcerative colitis , white blood cell , erythrocyte sedimentation rate , gastroenterology , cohort , prospective cohort study , disease
Objectives: The aim of this study was to assess common laboratory tests in identifying severe ulcerative colitis in children at diagnosis. Methods: A cohort of 427 children 4 to 17 years of age newly diagnosed with ulcerative colitis (UC) was prospectively enrolled. Boosted classification trees were used to characterize predictive ability of disease attributes based on clinical disease severity using Pediatric Ulcerative Colitis Activity Index (PUCAI), severe (65+) versus not severe (<65) and total Mayo score, severe (10–12) versus not severe (<10); mucosal disease by Mayo endoscopic subscore, severe (3) versus not severe (<3); and extensive disease versus not extensive (left‐sided and proctosigmoiditis). Results: Mean age was 12.7 years; 49.6% (n = 212) were girls, and 83% (n = 351) were Caucasian. Severe total Mayo score was present in 28% (n = 120), mean PUCAI score was 49.8 ± 20.1, and 33% (n = 142) had severe mucosal disease with extensive involvement in 82% (n = 353). Classification and regression trees identified white blood cell count, erythrocyte sedimentation rate, and platelet count (PLT) as the set of 3 best blood laboratory tests to predict disease extent and severity. For mucosal severity, albumin (Alb) replaced PLT. Classification models for PUCAI and total Mayo provided sensitivity of at least 0.65 using standard clinical cut‐points with misclassification rates of approximately 30%. Conclusions: A combination of the white blood cell count, erythrocyte sedimentation rate, and either PLT or albumin is the best predictive subset of standard laboratory tests to identify severe from nonsevere clinical or mucosal disease at diagnosis in relation to objective clinical scores.