Thrombocytosis – a Valuable Parameter for Assessing Severity of Crohn Disease Patients

Background and aim: Capsule endoscopy is the most sensitive method for evaluating mucosal lesions in Crohn’s Disease and recent studies show that capsule endoscopy could be used for disease staging and for careful monitoring to evaluate endoscopic activity on a regular basis. Over time, many platelet changes have been described in IBD, including morphological and functional alteration and increased number. We determined whether platelets count correlates with the endoscopic activity measured using capsule endoscopy in Crohn’s disease patients from a single center. Methods: This is a retrospective observational study. There were enrolled patients with suspected or known Crohn’s disease that underwent evaluation with capsule endoscopy in our department, between 2011 and 2021. For the evaluation with capsule endoscopy, Pillcam SB3 or Pillcam Colon2 were used. For the evaluation of endoscopic activity, we used Lewis score calculated using RAPID 8 capsule reading software. Platelets level was measured and correlated with the Lewis score, inflammatory biomarkers (C-reactive protein and fecal calprotectin) and anemic syndrome. Results: A total of 62 patients were included in the study, of whom 37 (59.67%) were with suspected Crohn’s disease and 25 (40.32%) were with known Crohn’s disease. Thrombocytosis was present in the majority of patients with severe endoscopic activity (Lewis score more than 790), elevated CRP, fecal calprotectin more than 250microg/g and anemic syndrome. Conclusion: To our knowledge, this is the first study that assess the correlation between thrombocytosis and severity of Crohn’s disease, evaluated with capsule endoscopy. Our data suggests that platelet count is a valuable, non-invasive, easy to use biomarker that is a good predictor of severity of Crohn’s disease and could have a prognostic value. It correlates well with Lewis score, CRP, fecal calprotectin and anemia.

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P138 Platelet-to-lymphocyte ratio index: a reliable tool for non-invasive assessment of endoscopic activity in small bowel Crohn’s Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.265 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S225-S225

Author(s):

V Macedo Silva ◽

M Freitas ◽

S Xavier ◽

T Cúrdia Gonçalves ◽

P Boal Carvalho ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

C Reactive Protein ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Non Invasive

Abstract Background The platelet-to-lymphocyte ratio (PLR) index has been a recent focus of investigation as a reliable marker of inflammation. This score was recently shown to have a good accuracy upon predicting endoscopic remission in patients with colonic Crohn’s Disease (CD). We aimed to assess the discriminative power of PLR index in patients with isolated small bowel CD. Methods Single center study of consecutive patients with isolated small bowel CD (L1 ± L4 disease according to Montreal classification) who underwent small bowel capsule endoscopy (SBCE) for assessment of endoscopic activity between January 2019 and December 2020. Only complete SBCEs were considered. CD endoscopic activity was classified according to the Lewis score (LS) value. Complete blood count, C-reactive protein and fecal calprotectin values were collected within 1 month of SBCE. Results Final sample included 49 patients, 35 (71.4%) of them females, with a mean age of 35.1±11.8 years. SBCE reported mucosal healing (LS<135) in 30.6% of the patients; mild activity (135≤LS<790) in 42.9% and moderate-to-severe activity (LS≥790) in 26.5% of the patients. PLR index positive correlation with LS was significant and moderate (k=0.597; p<0.001). This correlation was stronger than the one seen between fecal calprotectin (k=0.525; p=0.001) or C-reactive protein (k=0.321; p=0.029) and the LS score. In particular, PLR index presented an excellent accuracy for predicting patients with a moderate-to-severe endoscopic activity (AUC=0.908; 95%CI=0.816–0.999; p<0.001), with an optimal cut-off of PLR above 157 (sensitivity 92.3%; specificity 82.9%). The accuracy for prediction of mucosal healing was good (AUC=0.743; 95%CI=0.600–0.887; p=0.007), with an optimal cut-off of PLR below 126 (sensitivity 66.7%; specificity 80.0%). Conclusion PLR index demonstrated an excellent acuity for predicting patients with moderate to severe disease in small bowel CD. Moreover, it also demonstrated good acuity for predicting mucosal healing on this set of patients. These results come from a significant correlation of PLR index with endoscopic activity in small bowel CD. Our findings establish this index as a promising and easy-to-apply tool for non-invasive and regular follow-up of patients with small bowel CD.

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Combined evaluation of fecal calprotectin and C-reactive protein as a therapeutic target in the management of patients with Crohn's disease

Gastroenterología y Hepatología (English Edition) ◽

10.1016/j.gastre.2020.04.010 ◽

2021 ◽

Vol 44 (2) ◽

pp. 87-95

Author(s):

Francisco Guilherme Cancela Penna ◽

Rodrigo Macedo Rosa ◽

Fernando H. Pereira ◽

Pedro Ferrari Sales Cunha ◽

Stella Cristina S. Sousa ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Therapeutic Target ◽

Fecal Calprotectin ◽

C Reactive Protein ◽

Reactive Protein ◽

Combined Evaluation

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Capsule endoscopic findings correlate with fecal calprotectin and C-reactive protein in patients with suspected small-bowel Crohn’s disease

Scandinavian Journal of Gastroenterology ◽

10.3109/00365521.2014.920915 ◽

2014 ◽

Vol 49 (9) ◽

pp. 1084-1090 ◽

Cited By ~ 31

Author(s):

Charlotte M. Höög ◽

Lars-Åke Bark ◽

Olle Broström ◽

Urban Sjöqvist

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Fecal Calprotectin ◽

C Reactive Protein ◽

Reactive Protein ◽

Endoscopic Findings

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Su1934 A DIRECT COMPARISON OF FECAL CALPROTECTIN, HIGH-SENSITIVITY C-REACTIVE PROTEIN, AND LEUCIN-RICH ALPHA-2 GLYCOPROTEIN IN DETECTING ACTIVITY OF SMALL BOWEL CROHN'S DISEASE

Gastroenterology ◽

10.1016/s0016-5085(20)32460-4 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-708-S-709

Author(s):

Kunio Asonuma ◽

Shintaro Sagami ◽

Hiroki Kiyohara ◽

Mao Matsubayashi ◽

Hiromu Morikubo ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

High Sensitivity ◽

Fecal Calprotectin ◽

C Reactive Protein ◽

Reactive Protein

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DOP36 Non-invasive assessment of postoperative disease recurrence in Crohn’s Disease: A multicenter, prospective cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab073.075 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S074-S075

Author(s):

F Furfaro ◽

A Zilli ◽

V Craviotto ◽

A Aratari ◽

C Bezzio ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Wall ◽

Color Doppler ◽

Disease Recurrence ◽

Postoperative Recurrence ◽

Fecal Calprotectin ◽

Non Invasive ◽

Endoscopic Recurrence ◽

Sensitivity Specificity

Abstract Background Prevention of postoperative recurrence is a critical goal in Crohn’s disease (CD) management. Currently, postsurgical CD management and treatment are based on endoscopic monitoring performed within the first year after surgery. However, colonoscopy (CS) is an invasive and expensive procedure, unpleasant to patients. A non-invasive and patient friendly approach is required. Methods Consecutive CD patients who underwent ileo-cecal resection from July 2017 to January 2020 were prospectively enrolled in three Italian Centers and performed CS and bowel ultrasound (US) after six months from the surgery, in a blinded fashion. The patients also underwent complete clinical assessment and blood and stool samples were obtained for C-reactive protein (CRP), and fecal calprotectin (FC) measurements. The disease was considered clinically active if the Harvey–Bradshaw Index (HBI) was higher than 4. Uni- and multivariable analyses were used to assess the correlation between non-invasive parameters, including bowel US findings and FC values and endoscopic recurrence, defined by a Rutgeerts’s score (RS) > 2. Sensitivity, specificity, accuracy, PPV and NPV of bowel US parameters alone and in combination with FC in assessing endoscopic recurrence were calculated. Results Seventy patients were enrolled, 45 patients (64%) had an endoscopic recurrence (RS > 2) at 6 months. Thirteen out of 45 (29%) were symptomatic (HBI > 4). Bowel wall thickness (BWT), bowel wall flow (BWF, presence of vascular signals at color Doppler), the presence of mesenteric hypertrophy, the presence of limph-nodes and FC values significantly correlated with the endoscopic recurrence (p < 0.005). Independent predictors for endoscopic recurrence were BWT (for 1-mm increase: OR 2.63; 95% CI 1.136.12; p= 0.024), presence of lymph-nodes (OR 23.24; 95% CI 1.85291.15; p= 0.014) and FC > 50 µg/g (OR 11.86; 95% CI 2.60–54.09; p= 0.001). Sensitivity, specificity, accuracy, PPV and NPV of bowel US and/or FC are showed in Table 1. Table 1: Diagnostic accuracy of Bowel US and/or FC compared to CS in assessing endoscopic activity (CI 95%): per-patient analysis Conclusion Combined use of bowel US and FC is accurate in assessing endoscopic recurrence at 6 months in CD patients and represent a valid alternative to endoscopic assessment after surgery

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Panenteric capsule endoscopy identifies proximal small bowel disease guiding upstaging and treatment intensification in Crohn’s disease: A European multicentre observational cohort study

United European Gastroenterology Journal ◽

10.1177/2050640620948664 ◽

2020 ◽

pp. 205064062094866 ◽

Cited By ~ 1

Author(s):

Foong Way D Tai ◽

Pierre Ellul ◽

Alfonso Elosua ◽

Ignacio Fernandez-Urien ◽

Gian E Tontini ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Bowel Disease ◽

Mucosal Healing ◽

Small Bowel Disease ◽

Treatment Intensification ◽

Non Invasive ◽

Proximal Small Bowel

Background Endoscopically defined mucosal healing in Crohn’s disease is associated with improved outcomes. Panenteric capsule endoscopy enables a single non-invasive assessment of small and large bowel mucosal inflammation. Aims and methods: This multicentre observational study of patients with suspected and established Crohn’s disease examined the feasibility, safety and impact on patient outcomes of panenteric capsule endoscopy in routine clinical practice. The potential role in assessment of disease severity and extent by a comparison with existing clinical and biochemical markers is examined. Results Panenteric capsule endoscopy was performed on 93 patients (71 with established and 22 with suspected Crohn’s disease). A complete examination occurred in 85% (79/93). Two cases (2.8%) of capsule retention occurred in patients with established Crohn’s disease. Panenteric capsule resulted in management change in 38.7% (36/93) patients, including 64.6% (32/48) of those with an established diagnosis whose disease was active, and all three patients with newly diagnosed Crohn’s disease. Montreal classification was upstaged in 33.8% of patients with established Crohn’s disease and mucosal healing was demonstrated in 15.5%. Proximal small bowel disease upstaged disease in 12.7% and predicted escalation of therapy (odds ratio 40.3, 95% confidence interval 3.6–450.2). Raised C-reactive protein and faecal calprotectin were poorly sensitive in detecting active disease (0.48 and 0.59 respectively). Conclusions Panenteric capsule endoscopy was feasible in routine practice and the ability to detect proximal small bowel disease may allow better estimation of prognosis and guide treatment intensification. Panenteric capsule endoscopy may be a suitable non-invasive endoscopic investigation in determining disease activity and supporting management decisions.

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Serum MMP-9: a novel biomarker for prediction of clinical relapse in patients with quiescent Crohn’s disease, a post hoc analysis

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284819881590 ◽

2019 ◽

Vol 12 ◽

pp. 175628481988159 ◽

Cited By ~ 4

Author(s):

Doron Yablecovitch ◽

Uri Kopylov ◽

Adi Lahat ◽

Michal M. Amitai ◽

Eyal Klang ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Inflammation ◽

Area Under The Curve ◽

Fecal Calprotectin ◽

Clinical Relapse ◽

Post Hoc Analysis ◽

Reactive Protein ◽

Increased Risk ◽

Post Hoc

Background: Matrix metalloproteinase-9 (MMP-9) is a novel marker of intestinal inflammation. The aim of this study was to assess if serum MMP-9 levels predict clinical flare in patients with quiescent Crohn’s disease (CD). Methods: This study was a post hoc analysis of a prospective observational study in which quiescent CD patients were included and followed until clinical relapse or the end of a 2-year follow-up period. Serial C-reactive protein (CRP) and fecal calprotectin (FC) levels were measured, and the patients underwent repeated capsule endoscopies (CEs) every 6 months. Small bowel inflammation was quantified by Lewis score (LS) for CE. A baseline magnetic resonance enterography was also performed, and MaRIA score was calculated. Serum MMP-9 levels in baseline blood samples were quantified by ELISA. Results: Out of 58 eligible enrolled patients, 16 had a flare. Higher levels of baseline MMP-9 were found in patients who developed subsequent symptomatic flare compared with patients who did not [median 661 ng/ml, 25–75 interquartile range (IQR; 478.2–1441.3) versus 525.5 ng/ ml (339–662.7), respectively, p = 0.01]. Patients with serum MMP-9 levels of 945 ng/ ml or higher were at increased risk for relapse within 24 months [area under the curve (AUC) of 0.72 [95% confidence interval (CI): 0.56–0.88]; hazard ratio 8.1 (95% CI 3.0–21.9, p < 0.001)]. Serum MMP-9 concentrations showed weak and moderate correlation to baseline LS and FC, respectively ( r = 0.31, p = 0.02; r = 0.46, p < 0.001). No correlation was found between serum MMP-9 to CRP and MaRIA score. Conclusions: Serum MMP-9 may be a promising biomarker for prediction of clinical flare in CD patients with quiescent disease.

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