title: Fecal pyruvate kinase is not suitable for discrimination between inflammatory bowel disease exacerbation and acute gastroenteritis.
abstract: BACKGROUND
  In inflammatory bowel diseases (IBD) diarrhea can be caused by exacerbation and/or infectious agents. Fecal calprotectin (FC) is a well-established biomarker of intestinal inflammation in IBD. However, its usefulness in depiction of IBD exacerbation from infectious diarrhea is limited. The value of fecal pyruvate kinase isoenzyme type 2 (M2-PK) in this application remains unknown.
  
  
  OBJECTIVE
  To compare the performance of M2-PK and FC in discriminating between diarrhea caused by IBD and infectious agents.
  
  
  METHODS
  One hundred three patients were enrolled for the study, including 32 with ulcerative colitis (UC), 21 with Crohn's disease (CD), 29 with acute diarrhea caused by rotavirus (AD-RV), and 21 with acute diarrhea caused by Salmonella enteritidis (AD-SE). M2-PK and FC were measured using ELISA. Areas under receiver operating characteristic curves (AUCs), sensitivities and specificities for both tests in distinguishing between patient subgroups with moderate to severe UC and CD from AD-RV and AD-SE were calculated.
  
  
  RESULTS
  Differences in AUCs between M2-PK and FC for distinguishing UC [CD] from AD-RV were -0.06 (p < 0.028) [-0.10 (p < 0.0018)] and for differentiating UC [CD] from AD-SE were 0.03 (NS) [-0.19(p < 0.0011)].M2-PK sensitivities and specificities in distinguishing UC [CD] from AD-RV were 75.0%[71.4%] and 89.7% [89.7%] and for differentiation of UC [CD] from AD-SE were 56.3% [71.4%] and 95.2[57.1%].
  
  
  CONCLUSIONS
  The performance of M2-PK in distinguishing between children with moderate-to-severe IBD and patients with infectious gastroenteritis was inferior to FC. Neither test had sensitivity ands pecificity sufficient for everyday clinical application.
authors.affiliation: Child and Mother Specialist Hospital in Poznan, Poland.
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Czub
authors.affiliation: Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Jan K
authors.initials: JK
authors.lastname: Nowak
authors.affiliation: Department of Informatics and Statistics, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Moczko
authors.affiliation: Department of Pediatric Surgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Mankowski
authors.affiliation: Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Lisowska
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Banaszkiewicz
authors.affiliation: Department of General, Gastroenterological and Endocrinological Surgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Banasiewicz
authors.affiliation: Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Walkowiak
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000201:enzymology; D003424:Crohn Disease / Q000175:diagnosis / Q000201:enzymology; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000201:enzymology*; D005759:Gastroenteritis / Q000175:diagnosis* / Q000201:enzymology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000201:enzymology; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D011770:Pyruvate Kinase / Q000032:analysis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D011770:Pyruvate Kinase