Aim The purpose of this work was to evaluate the use of AGP as a screening test for paediatric patients referred with suspected inflammatory bowel disease, when compared to routine markers such as C-Reactive Protein (CRP), erythrocyte sedimentation rate (ESR) and faecal calprotectin (FC).
Method A retrospective study evaluated all patients under 18 years of age whose AGP was measured from September 2014 to September 2015; analysing laboratory investigations that were simultaneously performed and reviewing medical notes for presenting complaint and diagnosis.
Results A total of 58 tests were performed over 12 months. Fourteen results were excluded due to inadequate clinical information, making a total of 44 AGP levels in a patient population of 39 children (average age 12.3 years, male 46%).
Abdominal pain was the presenting complaint in over fifty percent of all children tested. Of these, seven children consequently or had already been diagnosed with IBD, giving a prevalence of 18% in this patient population.
A total of 16 positive AGP were identified (reference range normal ≤1.1g/L) with a range 0.07–3.28g/L and median 0.9g/L.
In the diagnosis of IBD, the sensitivity for AGP was 72.7% and specificity 75.8%. Positive predictive value was only 50%, however when focusing on a higher reference range of AGP >2.0g/L, this improved to 77.8%.
AGP when used in combination with 2 other positive markers (i.e. ESR/CRP/FCP) improved specificity, sensitivity and positive predictive value to 70%, 94% and 91.3% respectively.
Conclusion Abdominal pain is a common paediatric presentation, with IBD being one of several differential diagnoses. Almost two thirds of the patient’s tested had negative AGP levels, with no evidence of inflammatory bowel disease in over 80%. As a general paediatrician or gastroenterologist, the measurement of AGP is a useful investigation in the screening and diagnosis of paediatric inflammatory bowel disease. AGP >2.0g/L has a higher specificity and positive predictive value than CRP, ESR and faecal calprotectin. The diagnostic value of AGP is significantly improved when used in conjunction with other inflammatory markers and can be used to guide clinicians on who and when to refer to endoscopy.
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