Analysis and hierarchical clustering of blood results prior to diagnosis in paediatric inflammatory bowel disease
Analysis and hierarchical clustering of blood results prior to diagnosis in paediatric inflammatory bowel disease
Background: Pediatric inflammatory bowel disease (PIBD) is associated with a diagnostic delay. Blood tests are a routine part of the work-up in children with chronic abdominal symptoms (pain, diarrhea). Normal blood tests cannot exclude PIBD. We analyzed blood results at diagnosis over a 5-year period. Methods: Patients diagnosed from 2013 to 2017 were identified from the Southampton-PIBD database. Results were obtained up to 100 days before diagnostic endoscopy. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin, hemoglobin, platelets, packed cell volume (PCV), white cell count (WCC), and alanine transferase (ALT) were analyzed. Hierarchical clustering was applied to normalized results. Results: Two hundred fifty-six patients were included (Crohn's disease [CD], 151; ulcerative colitis [UC], 95; IBD-unclassified, 10; median age, 13.48 years; 36.7% female). Hierarchical clustering of patients revealed novel groupings enriched for CD and UC, characterized by specific patterns of results. In PIBD, 9% presented with all normal blood tests, 21.9% with normal CRP and ESR. Abnormal results were seen in all tests (ESR, 56.4% of patients; CRP, 53.4%; albumin, 28%; hemoglobin, 61.9%; platelets, 55.6%; PCV, 64.6%; WCC, 22.7%; and ALT, 7.2%). Normal inflammatory markers were more common in UC compared with CD (UC, 34%; CD, 15.8%; P = 0.0035). UC (14.4% normal) presented with all normal results more frequently than CD (CD, 5.3%; P = 0.02). CRP, ESR, and platelets were significantly higher in CD compared with UC. Albumin and hemoglobin were significantly lower. Conclusions: Most cases of PIBD present with >1 abnormal blood result, although 1/11 patients presents with normal blood tests and 1/5 present with normal inflammatory markers. Hierarchical clustering offers the potential to produce novel groupings to inform disease categorization and best management.
Crohn's disease, diagnostics, inflammatory bowel disease, pediatric, ulcerative colitis
469-475
Ashton, James J.
03369017-99b5-40ae-9a43-14c98516f37d
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Mossotto, Enrico
a2a572db-3e95-41c6-94f6-f1b019594372
Phan, Hang T. T.
2811b94c-62b7-459d-9cc1-c88057008e3b
Ennis, Sarah
7b57f188-9d91-4beb-b217-09856146f1e9
Beattie, R. Mark
9a66af0b-f81c-485c-b01d-519403f0038a
1 March 2020
Ashton, James J.
03369017-99b5-40ae-9a43-14c98516f37d
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Mossotto, Enrico
a2a572db-3e95-41c6-94f6-f1b019594372
Phan, Hang T. T.
2811b94c-62b7-459d-9cc1-c88057008e3b
Ennis, Sarah
7b57f188-9d91-4beb-b217-09856146f1e9
Beattie, R. Mark
9a66af0b-f81c-485c-b01d-519403f0038a
Ashton, James J., Borca, Florina, Mossotto, Enrico, Phan, Hang T. T., Ennis, Sarah and Beattie, R. Mark
(2020)
Analysis and hierarchical clustering of blood results prior to diagnosis in paediatric inflammatory bowel disease.
Inflammatory Bowel Diseases, 26 (3), .
(doi:10.1093/ibd/izy369).
Abstract
Background: Pediatric inflammatory bowel disease (PIBD) is associated with a diagnostic delay. Blood tests are a routine part of the work-up in children with chronic abdominal symptoms (pain, diarrhea). Normal blood tests cannot exclude PIBD. We analyzed blood results at diagnosis over a 5-year period. Methods: Patients diagnosed from 2013 to 2017 were identified from the Southampton-PIBD database. Results were obtained up to 100 days before diagnostic endoscopy. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin, hemoglobin, platelets, packed cell volume (PCV), white cell count (WCC), and alanine transferase (ALT) were analyzed. Hierarchical clustering was applied to normalized results. Results: Two hundred fifty-six patients were included (Crohn's disease [CD], 151; ulcerative colitis [UC], 95; IBD-unclassified, 10; median age, 13.48 years; 36.7% female). Hierarchical clustering of patients revealed novel groupings enriched for CD and UC, characterized by specific patterns of results. In PIBD, 9% presented with all normal blood tests, 21.9% with normal CRP and ESR. Abnormal results were seen in all tests (ESR, 56.4% of patients; CRP, 53.4%; albumin, 28%; hemoglobin, 61.9%; platelets, 55.6%; PCV, 64.6%; WCC, 22.7%; and ALT, 7.2%). Normal inflammatory markers were more common in UC compared with CD (UC, 34%; CD, 15.8%; P = 0.0035). UC (14.4% normal) presented with all normal results more frequently than CD (CD, 5.3%; P = 0.02). CRP, ESR, and platelets were significantly higher in CD compared with UC. Albumin and hemoglobin were significantly lower. Conclusions: Most cases of PIBD present with >1 abnormal blood result, although 1/11 patients presents with normal blood tests and 1/5 present with normal inflammatory markers. Hierarchical clustering offers the potential to produce novel groupings to inform disease categorization and best management.
Text
Untracked_03_10_18_Analysis and HC in PIBD
- Accepted Manuscript
More information
Accepted/In Press date: 5 October 2018
e-pub ahead of print date: 17 December 2018
Published date: 1 March 2020
Additional Information:
Funding Information:
Supported by: This manuscript has no specific funding. J.J.A. is funded by an Action Medical Research Research Training fellowship. This study is supported by the National Institute for Health Research through the National Institute for Health Research Southampton Biomedical Research Centre.
Publisher Copyright:
© 2018 Crohn's & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Copyright © 2018, Oxford University Press
Keywords:
Crohn's disease, diagnostics, inflammatory bowel disease, pediatric, ulcerative colitis
Identifiers
Local EPrints ID: 425282
URI: http://eprints.soton.ac.uk/id/eprint/425282
PURE UUID: 306ff338-ca9a-49ee-a9f3-7ee3f4c49c04
Catalogue record
Date deposited: 12 Oct 2018 16:30
Last modified: 16 Mar 2024 07:10
Export record
Altmetrics
Contributors
Author:
Florina Borca
Author:
Enrico Mossotto
Author:
Hang T. T. Phan
Author:
R. Mark Beattie
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
