Pediatr Gastroenterol Nutr. 2023 Jun 1;76(6):756-762. doi: 10.1097/MPG.0000000000003755.Epub 2023 Feb 23.

Xiaoyi Zhang 1, Claudia Ramos-Rivers 2, Krishnapriya Prathapan 3, Xianling Wang 4, Gong Tang 5, Sandra Kim 6, David G Binion 2

Author information

1 From the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Indiana University, Riley Hospital for Children, Indianapolis, IN.

2 the Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center Children's Hospital, Pittsburgh, PA.

3 Valleywise Health Medical Center, Phoenix, AZ.

4 Bristol-Myers Squibb, Princeton, NJ.

5 the Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA.

6 the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA.

Abstract

Objectives:?Peripheral blood monocytosis (PBM) is a marker of increased disease severity in adults with inflammatory bowel diseases (IBDs). We sought to determine whether PBM serves as a prognostic biomarker in patients with pediatric-onset IBD for a more aggressive long-term disease course when followed into adulthood. 

Methods:?Patients with pediatric-onset inflammatory bowel disease were identified within an adult tertiary care center, within a consented, prospectively collected natural history disease registry, to compare clinical outcomes between patients with and without PBM from the years 2009 to 2019. Patients demonstrating elevation in PBM at any time defined membership and long-term clinical trajectories were compared with pediatric-onset patients without PBM. 

Results:?A total of 581 patients with IBD, diagnosed by 18 years of age, were identified for inclusion, of which 440 patients were diagnosed with Crohn disease and 141 with ulcerative colitis. Monocytosis was detected by complete blood cell counts in 40.1% of patients. PBM was associated with steroid and biologic exposure, number of IBD-related surgeries, and increased health care utilization. Multivariate logistic regression analyses, accounting for elevation of inflammatory markers and other values associated with acute disease activity as well as steroid use, showed persistently increased odds of biologic exposure, emergency department visits, and hospitalizations, but not surgeries, after detection of monocytosis. 

Conclusions:?Within patients with pediatric-onset IBD, the sub-cohort with PBM had associated worse clinical outcomes and other markers of increased disease severity.