James Irwin1,2,3, Anton Lord4, Emma Ferguson5, Lisa A Simms4, Katherine Hanigan4, Carlos A Montoya6,7, Graham Radford-Smith4,5,8. 1. QIMR Berghofer Medical Research Institute, Brisbane, Australia. jamesi@mdhb.health.nz. 2. Faculty of Medicine, The University of Queensland, Brisbane, Australia. jamesi@mdhb.health.nz. 3. Department of Gastroenterology, Palmerston North Hospital, 50 Ruahine Street, Palmerston North, 4442, New Zealand. jamesi@mdhb.health.nz. 4. QIMR Berghofer Medical Research Institute, Brisbane, Australia. 5. Faculty of Medicine, The University of Queensland, Brisbane, Australia. 6. Smart Foods Innovation Centre of Excellence, AgResearch Limited, Te Ohu Rangahau Kai Facility, Palmerston North, 4474, New Zealand. 7. Riddet Institute, Massey University, Te Ohu Rangahau Kai Facility, Palmerston North, 4474, New Zealand. 8. Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Abstract
BACKGROUND: Stenosis, fistulization, and perforation of the bowel are severe outcomes which can occur in patients with Crohn's disease. Accurate prediction of these events may enable clinicians to alter treatment strategies and avoid these outcomes. AIMS: To study the correlation between longitudinal laboratory testing and subsequent intestinal complications in patients with Crohn's disease. METHODS: An observational cohort of patients with Crohn's disease at a single center were analyzed between 01/01/1994 and 06/30/2016. A complication was defined as the development of an intestinal fistula, stenosis, or perforation. Exploratory analysis using Cox regression was performed to select the best statistical method to represent longitudinal laboratory data. Cox regression was used to identify laboratory variables independently associated with the development of a subsequent complication. A clinical scoring tool was designed. RESULTS: In 246 patients observed over a median of 5.72 years, 134 complications occurred. Minimum or maximum value in a preceding window period of one year was most strongly associated with subsequent complication. A Longitudinal Laboratory score of ≥ 2 (maximum albumin level < 39 g/L = 1, maximum mean cell volume < 88 fL = 1, minimum platelet count > 355 × 109/L = 1, minimum C reactive protein > 5 mg/L = 1) was 62% sensitive and 91% specific in identifying patients who develop a subsequent complication. CONCLUSION: A consistent reduction in serum albumin and mean cell volume, and a consistent increase in platelet count and C reactive protein were associated with a subsequent complication in patients with Crohn's disease. Longitudinal laboratory tests may be used as described in this paper to provide a rational for earlier escalation of therapy.
BACKGROUND: Stenosis, fistulization, and perforation of the bowel are severe outcomes which can occur in patients with Crohn's disease. Accurate prediction of these events may enable clinicians to alter treatment strategies and avoid these outcomes. AIMS: To study the correlation between longitudinal laboratory testing and subsequent intestinal complications in patients with Crohn's disease. METHODS: An observational cohort of patients with Crohn's disease at a single center were analyzed between 01/01/1994 and 06/30/2016. A complication was defined as the development of an intestinal fistula, stenosis, or perforation. Exploratory analysis using Cox regression was performed to select the best statistical method to represent longitudinal laboratory data. Cox regression was used to identify laboratory variables independently associated with the development of a subsequent complication. A clinical scoring tool was designed. RESULTS: In 246 patients observed over a median of 5.72 years, 134 complications occurred. Minimum or maximum value in a preceding window period of one year was most strongly associated with subsequent complication. A Longitudinal Laboratory score of ≥ 2 (maximum albumin level < 39 g/L = 1, maximum mean cell volume < 88 fL = 1, minimum platelet count > 355 × 109/L = 1, minimum C reactive protein > 5 mg/L = 1) was 62% sensitive and 91% specific in identifying patients who develop a subsequent complication. CONCLUSION: A consistent reduction in serum albumin and mean cell volume, and a consistent increase in platelet count and C reactive protein were associated with a subsequent complication in patients with Crohn's disease. Longitudinal laboratory tests may be used as described in this paper to provide a rational for earlier escalation of therapy.
Authors: B G Feagan; R N Fedorak; E J Irvine; G Wild; L Sutherland; A H Steinhart; G R Greenberg; J Koval; C J Wong; M Hopkins; S B Hanauer; J W McDonald Journal: N Engl J Med Date: 2000-06-01 Impact factor: 91.245
Authors: Kelvin T Thia; William J Sandborn; William S Harmsen; Alan R Zinsmeister; Edward V Loftus Journal: Gastroenterology Date: 2010-07-14 Impact factor: 22.682
Authors: B G Feagan; J Rochon; R N Fedorak; E J Irvine; G Wild; L Sutherland; A H Steinhart; G R Greenberg; R Gillies; M Hopkins Journal: N Engl J Med Date: 1995-02-02 Impact factor: 91.245
Authors: Mark Lazarev; Thomas Ullman; Wolfgang H Schraut; Kevin E Kip; Melissa Saul; Miguel Regueiro Journal: Inflamm Bowel Dis Date: 2010-05 Impact factor: 5.325