title: Low predictive value of histopathological scoring system for complications development in children with Crohn's disease.
abstract: OBJECTIVE
  In pediatric Crohn's disease (PCD), the benefit of microscopy in disease activity assessment and prediction of clinical outcome is, due to the focality and transmurality of the inflammation, disputable. We investigated whether histopathological scoring system predicts complications in pediatric CD and correlates with endoscopical and clinical scores.
  
  
  METHODS
  We performed a retrospective study on 63 patients. Endoscopy in the time of diagnosis was evaluated using the Simple Endoscopic Score (SES) and histopathology with the Global Histology Activity Score, both in its original version (GHAS) and its modification (modGHAS). Pediatric Crohn's Disease Activity Index (PCDAI) was also calculated. The patients were grouped according to the presence or absence of defined complications (intraabdominal abscess or fistula, perianal fistulating disease or stricture impenetrable for endoscope or with prestenotic dilatation) during one year of follow-up, or the necessity to initiate anti-TNF treatment for persisting or relapsing active disease in the same time period. Associations were tested with Cox regression analysis.
  
  
  RESULTS
  SES was higher in patients with complications. However, in case of GHAS, modGHAS and PCDAI we did not find any significant association with complicated course of disease. SES above 16 points was revealed as an independent risk factor for complications development in PCD, in contrary to GHAS, modGHAS and PCDAI. We demonstrated only a weak correlation between GHAS, modGHAS and SES and no correlation between the histopathological scoring systems and PCDAI.
  
  
  CONCLUSIONS
  In conclusion, the histopathological scoring system cannot be recommended as a reliable predictor of development of complications in children with CD.
authors.affiliation: Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czechia. Electronic address: Ondrej.Fabian2@fnmotol.cz.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Fabian
authors.affiliation: Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czechia.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Hradsky
authors.affiliation: Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czechia.
authors.forename: Kristyna
authors.initials: K
authors.lastname: Potuznikova
authors.affiliation: Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czechia.
authors.forename: Alena
authors.initials: A
authors.lastname: Kalfusova
authors.affiliation: Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czechia.
authors.forename: Lenka
authors.initials: L
authors.lastname: Krskova
authors.affiliation: Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czechia.
authors.forename: Ludmila
authors.initials: L
authors.lastname: Hornofova
authors.affiliation: Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czechia.
authors.forename: Josef
authors.initials: J
authors.lastname: Zamecnik
authors.affiliation: Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Uvalu 84, Prague 5, 150 06, Czechia.
authors.forename: Jiri
authors.initials: J
authors.lastname: Bronsky
mesh_terms: D000293:Adolescent; D002648:Child; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Global histology activity score; PCDAI; Prognosis; Scoring system; Simple endoscopic score