BACKGROUND: Patient-reported Crohn's disease (CD) symptoms and endoscopic evaluation have historically guided routine care, but the risk of complications in asymptomatic patients with elevated C-reactive protein (CRP) is unknown. METHODS: We conducted a prospective observational cohort study of patients with CD from a tertiary care center. Subjects with short inflammatory bowel disease questionnaire scores ≥ 50, Harvey-Bradshaw CD scores ≤ 4, and same-day CRP measurement were eligible for inclusion. The primary outcome was disease-related hospitalization up to 24 months after the qualifying clinic visit. We assessed the relationship between CRP elevation and subsequent hospitalization. RESULTS: There were 351 asymptomatic patients with CD (median age 40 yr; 50.4% female) who met inclusion criteria, and CRP was elevated in 19.7% of these individuals (n = 69). At 24 months, 16.8% (n = 59) of the study population had been hospitalized for CD-related complications. Significantly, more patients with an elevated CRP were hospitalized (33.3% versus 12.8%, P < 0.0001) compared with those with a normal CRP and were hospitalized at increased rate (P < 0.001) on Kaplan-Meier analysis. CRP elevation was significantly and independently associated with increased risk of hospitalization (adjusted hazard ratio 2.12; 95% confidence interval, 1.13-3.98; P = 0.02) in multivariable survival analysis. CONCLUSIONS: Asymptomatic patients with CD with elevated CRP are at a nearly 2-fold higher risk for hospitalization over the subsequent 2 years compared with asymptomatic patients with CD without CRP elevation.
BACKGROUND: Patient-reported Crohn's disease (CD) symptoms and endoscopic evaluation have historically guided routine care, but the risk of complications in asymptomatic patients with elevated C-reactive protein (CRP) is unknown. METHODS: We conducted a prospective observational cohort study of patients with CD from a tertiary care center. Subjects with short inflammatory bowel disease questionnaire scores ≥ 50, Harvey-Bradshaw CD scores ≤ 4, and same-day CRP measurement were eligible for inclusion. The primary outcome was disease-related hospitalization up to 24 months after the qualifying clinic visit. We assessed the relationship between CRP elevation and subsequent hospitalization. RESULTS: There were 351 asymptomatic patients with CD (median age 40 yr; 50.4% female) who met inclusion criteria, and CRP was elevated in 19.7% of these individuals (n = 69). At 24 months, 16.8% (n = 59) of the study population had been hospitalized for CD-related complications. Significantly, more patients with an elevated CRP were hospitalized (33.3% versus 12.8%, P < 0.0001) compared with those with a normal CRP and were hospitalized at increased rate (P < 0.001) on Kaplan-Meier analysis. CRP elevation was significantly and independently associated with increased risk of hospitalization (adjusted hazard ratio 2.12; 95% confidence interval, 1.13-3.98; P = 0.02) in multivariable survival analysis. CONCLUSIONS: Asymptomatic patients with CD with elevated CRP are at a nearly 2-fold higher risk for hospitalization over the subsequent 2 years compared with asymptomatic patients with CD without CRP elevation.
Authors: Julajak Limsrivilai; Ryan W Stidham; Shail M Govani; Akbar K Waljee; Wen Huang; Peter D R Higgins Journal: Clin Gastroenterol Hepatol Date: 2016-09-17 Impact factor: 11.382
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Authors: Alyce J M Anderson; Benjamin Click; Claudia Ramos-Rivers; Dmitriy Babichenko; Ioannis E Koutroubakis; Douglas J Hartman; Jana G Hashash; Marc Schwartz; Jason Swoger; Arthur M Barrie; Michael A Dunn; Miguel Regueiro; David G Binion Journal: Dig Dis Sci Date: 2016-09-12 Impact factor: 3.199
Authors: Eugene Gonzalez-Lopez; Yuka Imamura Kawasawa; Vonn Walter; Lijun Zhang; Walter A Koltun; Xuemei Huang; Kent E Vrana; Matthew D Coates Journal: Front Med (Lausanne) Date: 2018-11-27
Authors: Alyce Anderson; Cynthia Cherfane; Benjamin Click; Claudia Ramos-Rivers; Ioannis E Koutroubakis; Jana G Hashash; Dmitriy Babichenko; Gong Tang; Michael Dunn; Arthur Barrie; Siobhan Proksell; Jeffrey Dueker; Elyse Johnston; Marc Schwartz; David G Binion Journal: Inflamm Bowel Dis Date: 2022-01-05 Impact factor: 5.325