Do elevated inflammatory markers predict disease types in children with inflammatory bowel disease?

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Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) are routinely employed inflammatory markers in inflammatory bowel disease (IBD). Despite the presence of active disease, some patients have low or normal levels of these inflammatory markers. This study analyzes clinical predictors of elevation of inflammatory markers in IBD types and subtypes in children and adults. To identify and compare association of inflammatory markers in children and adults with active IBD A retrospective analysis of records included children with IBD seen at our institution between 2001 -07 with evidence of active disease at the time of diagnosis on biopsies. Age at diagnosis, gender, disease (Crohns, Ulcerative Colitis and Indeterminate Colitis), location, CRP, ESR at time of endoscopy, and serum albumin were recorded. CD was categorized as fistulizing (including perianal disease) and non fistulizing (inflammatory and fibrostenotic) and UC as left-sided or pancolonic. This data was compared with previously available data in adults with IBD. Statistical analysis used included non parametric testing for univariate analysis and multiple regression to control for confounding. Study included 54 children (Mean age 11 years and range 3-18): 30 with CD, 18 with UC and 6 with IC and 92 adults (mean age 36 yrs. range 14-68) 64 with CD and 28 with UC. Children with CD had an elevated CRP compared with UC (2.73 vs. 0.70; p 0.04). Mean ESR was higher in CD than UC children but not statistically significant (38.5 vs. 29.5 p 0.3). Children with IC showed higher CRP than UC (1.7 vs. 0.7 p 0.02) but not with CD while ESR did not show a statistical difference. In adults, CD and UC showed comparable mean CRP (3.2 vs. 5.5; p ns). Stricturing was associated with lower mean CRP (1.1) than fistulizing (5.3) and inflammatory (3.7) phenotypes of CD (p 0.02). No difference was noted between fistulizing and non-fistulizing phenotypes in children. Serum albumin showed a positive correlation in children with both ESR (r 0.72, p 0.001) and CRP (r 0.43, p 0.03). Among UC adult subjects, pancolitis was associated with a higher CRP in contrast with left-sided colitis (5.1 vs. 2.7; p 0.02). Children showed a small correlation with the extent of colonic involvement(r 0.57, p 0.03.) but not on non-parametric testing (p 0.1). Adults and children with IBD differ with respect to elevation of inflammatory markers. Children with active CD have higher CRP compared with UC compared with adults. Inflammatory markers did not differ in fistulizing and non fistulizing CD or between pancolonic and left sided UC in children in contrast with adults. In children serum albumin displays a positive correlation with inflammatory markers. The study had a small number of subjects in some groups (e.g. IC). The disease severity was not prospectively assessed.