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Analysis of Using the Total White Blood Cell Count to Define Severe New-onset Ulcerative Colitis in Children. J Pediatr Gastroenterol Nutr 2020 09;71(3):354-360



Pubmed ID


Pubmed Central ID




Scopus ID

2-s2.0-85089816897   1 Citation


OBJECTIVES: The aim of this study was to assess common laboratory tests in identifying severe ulcerative colitis in children at diagnosis.

METHODS: A cohort of 427 children 4 to 17 years of age newly diagnosed with ulcerative colitis (UC) was prospectively enrolled. Boosted classification trees were used to characterize predictive ability of disease attributes based on clinical disease severity using Pediatric Ulcerative Colitis Activity Index (PUCAI), severe (65+) versus not severe (<65) and total Mayo score, severe (10-12) versus not severe (<10); mucosal disease by Mayo endoscopic subscore, severe (3) versus not severe (<3); and extensive disease versus not extensive (left-sided and proctosigmoiditis).

RESULTS: Mean age was 12.7 years; 49.6% (n = 212) were girls, and 83% (n = 351) were Caucasian. Severe total Mayo score was present in 28% (n = 120), mean PUCAI score was 49.8 ± 20.1, and 33% (n = 142) had severe mucosal disease with extensive involvement in 82% (n = 353). Classification and regression trees identified white blood cell count, erythrocyte sedimentation rate, and platelet count (PLT) as the set of 3 best blood laboratory tests to predict disease extent and severity. For mucosal severity, albumin (Alb) replaced PLT. Classification models for PUCAI and total Mayo provided sensitivity of at least 0.65 using standard clinical cut-points with misclassification rates of approximately 30%.

CONCLUSIONS: A combination of the white blood cell count, erythrocyte sedimentation rate, and either PLT or albumin is the best predictive subset of standard laboratory tests to identify severe from nonsevere clinical or mucosal disease at diagnosis in relation to objective clinical scores.

Author List

Mack DR, Saul B, Boyle B, Griffiths A, Sauer C, Markowitz J, LeLeiko N, Keljo D, Rosh JR, Baker SS, Steiner S, Heyman MB, Patel AS, Baldassano R, Noe J, Rufo P, Kugathasan S, Walters T, Marquis A, Thomas SM, Denson L, Hyams J, PROTECT STUDY GROUP


Joshua D. Noe MD Associate Dean, Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blood Sedimentation
Colitis, Ulcerative
Leukocyte Count
Severity of Illness Index