ADVERTISEMENT
Which Endoscopic Severity Assessment Tool Correlates Best With Non-Invasive Crohn’s Disease Activity Parameters?
AIBD 2023
Background:
Although there are several scores for endoscopic severity assessment in Crohn’s disease (CD), there is conflicting and scarce information regarding their agreement and relationship with laboratory non-invasive parameters, namely C-reactive protein (CRP) and fecal calprotectin (FC). We aimed to investigate the agreement between the Simple Endoscopic Score for Crohn’s Disease (SES-CD), Modified Multiplier SES-CD (MM-SES-CD), and the recently suggested Toronto Inflammatory Bowel Disease Global Endoscopic Reporting (TIGER) score and their correlation with CRP and FC in CD.
Methods:
Retrospective cohort-study including all ileocolonoscopies performed in adult CD patients between January 2021 and July 2023 with CRP (mg/dL) and FC (ug/g) collected within one month. Patients with previous intestinal surgery or inadequate bowel preparation were excluded. Agreement between SES-CD (active disease >3), MM-SES-CD (active disease ≥ 14), and TIGER scores (active disease ≥ 100) was determined using Kappa statistics (k) and each value was correlated with laboratorial biomarkers using Spearman’s correlation coefficients (rho).
Results:
A total of 312 ileocolonoscopies from 246 CD patients were included, most females (52.9%) with a mean age of 42 ± 14 years old. According to Montreal Classification, most patients had A2 (71.2%), L1 (47.8%) and B1 (69.6%) disease. Median SES-CD, MM-SES-CD, TIGER scores were 3, 12, and 3 points, respectively. The mean/median value of CRP was 2.9 mg/dL, while mean FC value was 243 ug/g. There was an excellent, strong, and moderate agreement between SES-CD and MM-SES-CD (k = 0.929, P< 0.001), SES-CD and TIGER (k = 0.682, P< 0.001), and MM-SES-CD and TIGER score (k = 0.504, P< 0.001), respectively. There was a fair correlation between SES-CD (rho = 0.412), MM-SES-CD (rho = 0.423), TIGER score (rho = 0.430) and CRP (P< 0.001). SES-CD (rho = 0.563), MM-SES-CD (rho = 0.540) had a fair correlation and TIGER score (rho = 0.610) had a moderate correlation with FC (P< 0.001).
Conclusions:
Although existing Crohn’s disease endoscopic severity scores have moderate to strong agreement regarding endoscopic activity, they continue to have suboptimal correlation with laboratory non-invasive biomarkers.
