Analysis of Using the Total White Blood Cell Count to Define Severe New‐onset Ulcerative Colitis in Children
ABSTRACT 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 t...
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| Veröffentlicht in: | Journal of pediatric gastroenterology and nutrition 2020-09, Vol.71 (3), p.354-360 |
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| creator | 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 |
| description | ABSTRACT
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 ( |
| doi_str_mv | 10.1097/MPG.0000000000002797 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8482284</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2412211745</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5567-f3af4635a1888954836f059712fdcae40a0456861787402feef5dfefda0d843c3</originalsourceid><addsrcrecordid>eNqNkdFuFCEUhonR2HX1DYzh0ptpgYEZ9kKTdrRVU2sTu_GS4Myhg7JQgd3N3vURfEafRJpdm-qFSkLIge__gfMj9JSSfUpm7cH785N9cmewdtbeQxMq6qbiktD7aFL22opR2uyhRyl9KVDLBXmI9momGJE1mSB_6LXbJJtwMHierL_EeQR8EbJ2-NNoM-AjF8KAO3AOd2HpM84BvwJjPeCPsIII-AzWP66_B58g47nrIepsV1BoZ3Nxth53o3VDBP8YPTDaJXiyW6dofvz6ontTnX44edsdnla9EE1bmVob3tRCUynlTHBZN4aIWUuZGXoNnGjCRSMb2sqWE2YAjBgMmEGTQfK6r6fo5db3avl5AUMPPkft1FW0Cx03Kmirfj_xdlSXYaUkl4wViyl6vjOI4dsSUlYLm_rSA-0hLJNinLLS2dLPgvIt2seQUgRzew0l6iYqVaJSf0ZVZM_uPvFW9CubAsgtsA4uQ0xf3XINUY2gXR7_5c3_Ir3BBG2bihFGyKxUVZm0LrIXO5l1sPmvb6h352f10XExKnn9BDR6wq8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2412211745</pqid></control><display><type>article</type><title>Analysis of Using the Total White Blood Cell Count to Define Severe New‐onset Ulcerative Colitis in Children</title><source>Access via Wiley Online Library</source><creator>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</creator><creatorcontrib>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 ; PROTECT STUDY GROUP ; PROTECT STUDY GROUP</creatorcontrib><description>ABSTRACT
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.</description><identifier>ISSN: 0277-2116</identifier><identifier>EISSN: 1536-4801</identifier><identifier>DOI: 10.1097/MPG.0000000000002797</identifier><identifier>PMID: 32520830</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>classification tree analysis ; inflammatory bowel disease ; laboratory values</subject><ispartof>Journal of pediatric gastroenterology and nutrition, 2020-09, Vol.71 (3), p.354-360</ispartof><rights>2020 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition</rights><rights>Lippincott Williams & Wilkins</rights><rights>2020 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5567-f3af4635a1888954836f059712fdcae40a0456861787402feef5dfefda0d843c3</citedby><cites>FETCH-LOGICAL-c5567-f3af4635a1888954836f059712fdcae40a0456861787402feef5dfefda0d843c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1097%2FMPG.0000000000002797$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1097%2FMPG.0000000000002797$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32520830$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mack, David R.</creatorcontrib><creatorcontrib>Saul, Bradley</creatorcontrib><creatorcontrib>Boyle, Brendan</creatorcontrib><creatorcontrib>Griffiths, Anne</creatorcontrib><creatorcontrib>Sauer, Cary</creatorcontrib><creatorcontrib>Markowitz, James</creatorcontrib><creatorcontrib>LeLeiko, Neal</creatorcontrib><creatorcontrib>Keljo, David</creatorcontrib><creatorcontrib>Rosh, Joel R.</creatorcontrib><creatorcontrib>Baker, Susan S.</creatorcontrib><creatorcontrib>Steiner, Steve</creatorcontrib><creatorcontrib>Heyman, Melvin B.</creatorcontrib><creatorcontrib>Patel, Ashish S.</creatorcontrib><creatorcontrib>Baldassano, Robert</creatorcontrib><creatorcontrib>Noe, Joshua</creatorcontrib><creatorcontrib>Rufo, Paul</creatorcontrib><creatorcontrib>Kugathasan, Subra</creatorcontrib><creatorcontrib>Walters, Thomas</creatorcontrib><creatorcontrib>Marquis, Alison</creatorcontrib><creatorcontrib>Thomas, Sonia M.</creatorcontrib><creatorcontrib>Denson, Lee</creatorcontrib><creatorcontrib>Hyams, Jeffrey</creatorcontrib><creatorcontrib>PROTECT STUDY GROUP</creatorcontrib><creatorcontrib>PROTECT STUDY GROUP</creatorcontrib><title>Analysis of Using the Total White Blood Cell Count to Define Severe New‐onset Ulcerative Colitis in Children</title><title>Journal of pediatric gastroenterology and nutrition</title><addtitle>J Pediatr Gastroenterol Nutr</addtitle><description>ABSTRACT
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.</description><subject>classification tree analysis</subject><subject>inflammatory bowel disease</subject><subject>laboratory values</subject><issn>0277-2116</issn><issn>1536-4801</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqNkdFuFCEUhonR2HX1DYzh0ptpgYEZ9kKTdrRVU2sTu_GS4Myhg7JQgd3N3vURfEafRJpdm-qFSkLIge__gfMj9JSSfUpm7cH785N9cmewdtbeQxMq6qbiktD7aFL22opR2uyhRyl9KVDLBXmI9momGJE1mSB_6LXbJJtwMHierL_EeQR8EbJ2-NNoM-AjF8KAO3AOd2HpM84BvwJjPeCPsIII-AzWP66_B58g47nrIepsV1BoZ3Nxth53o3VDBP8YPTDaJXiyW6dofvz6ontTnX44edsdnla9EE1bmVob3tRCUynlTHBZN4aIWUuZGXoNnGjCRSMb2sqWE2YAjBgMmEGTQfK6r6fo5db3avl5AUMPPkft1FW0Cx03Kmirfj_xdlSXYaUkl4wViyl6vjOI4dsSUlYLm_rSA-0hLJNinLLS2dLPgvIt2seQUgRzew0l6iYqVaJSf0ZVZM_uPvFW9CubAsgtsA4uQ0xf3XINUY2gXR7_5c3_Ir3BBG2bihFGyKxUVZm0LrIXO5l1sPmvb6h352f10XExKnn9BDR6wq8</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Mack, David R.</creator><creator>Saul, Bradley</creator><creator>Boyle, Brendan</creator><creator>Griffiths, Anne</creator><creator>Sauer, Cary</creator><creator>Markowitz, James</creator><creator>LeLeiko, Neal</creator><creator>Keljo, David</creator><creator>Rosh, Joel R.</creator><creator>Baker, Susan S.</creator><creator>Steiner, Steve</creator><creator>Heyman, Melvin B.</creator><creator>Patel, Ashish S.</creator><creator>Baldassano, Robert</creator><creator>Noe, Joshua</creator><creator>Rufo, Paul</creator><creator>Kugathasan, Subra</creator><creator>Walters, Thomas</creator><creator>Marquis, Alison</creator><creator>Thomas, Sonia M.</creator><creator>Denson, Lee</creator><creator>Hyams, Jeffrey</creator><general>Lippincott Williams & Wilkins</general><general>by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202009</creationdate><title>Analysis of Using the Total White Blood Cell Count to Define Severe New‐onset Ulcerative Colitis in Children</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5567-f3af4635a1888954836f059712fdcae40a0456861787402feef5dfefda0d843c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>classification tree analysis</topic><topic>inflammatory bowel disease</topic><topic>laboratory values</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mack, David R.</creatorcontrib><creatorcontrib>Saul, Bradley</creatorcontrib><creatorcontrib>Boyle, Brendan</creatorcontrib><creatorcontrib>Griffiths, Anne</creatorcontrib><creatorcontrib>Sauer, Cary</creatorcontrib><creatorcontrib>Markowitz, James</creatorcontrib><creatorcontrib>LeLeiko, Neal</creatorcontrib><creatorcontrib>Keljo, David</creatorcontrib><creatorcontrib>Rosh, Joel R.</creatorcontrib><creatorcontrib>Baker, Susan S.</creatorcontrib><creatorcontrib>Steiner, Steve</creatorcontrib><creatorcontrib>Heyman, Melvin B.</creatorcontrib><creatorcontrib>Patel, Ashish S.</creatorcontrib><creatorcontrib>Baldassano, Robert</creatorcontrib><creatorcontrib>Noe, Joshua</creatorcontrib><creatorcontrib>Rufo, Paul</creatorcontrib><creatorcontrib>Kugathasan, Subra</creatorcontrib><creatorcontrib>Walters, Thomas</creatorcontrib><creatorcontrib>Marquis, Alison</creatorcontrib><creatorcontrib>Thomas, Sonia M.</creatorcontrib><creatorcontrib>Denson, Lee</creatorcontrib><creatorcontrib>Hyams, Jeffrey</creatorcontrib><creatorcontrib>PROTECT STUDY GROUP</creatorcontrib><creatorcontrib>PROTECT STUDY GROUP</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of pediatric gastroenterology and nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mack, David R.</au><au>Saul, Bradley</au><au>Boyle, Brendan</au><au>Griffiths, Anne</au><au>Sauer, Cary</au><au>Markowitz, James</au><au>LeLeiko, Neal</au><au>Keljo, David</au><au>Rosh, Joel R.</au><au>Baker, Susan S.</au><au>Steiner, Steve</au><au>Heyman, Melvin B.</au><au>Patel, Ashish S.</au><au>Baldassano, Robert</au><au>Noe, Joshua</au><au>Rufo, Paul</au><au>Kugathasan, Subra</au><au>Walters, Thomas</au><au>Marquis, Alison</au><au>Thomas, Sonia M.</au><au>Denson, Lee</au><au>Hyams, Jeffrey</au><aucorp>PROTECT STUDY GROUP</aucorp><aucorp>PROTECT STUDY GROUP</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of Using the Total White Blood Cell Count to Define Severe New‐onset Ulcerative Colitis in Children</atitle><jtitle>Journal of pediatric gastroenterology and nutrition</jtitle><addtitle>J Pediatr Gastroenterol Nutr</addtitle><date>2020-09</date><risdate>2020</risdate><volume>71</volume><issue>3</issue><spage>354</spage><epage>360</epage><pages>354-360</pages><issn>0277-2116</issn><eissn>1536-4801</eissn><abstract>ABSTRACT
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.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>32520830</pmid><doi>10.1097/MPG.0000000000002797</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | Access via Wiley Online Library |
| subjects | classification tree analysis inflammatory bowel disease laboratory values |
| title | Analysis of Using the Total White Blood Cell Count to Define Severe New‐onset Ulcerative Colitis in Children |
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