Longitudinal Laboratory Data Predicts Complication in Crohn’s Disease Patients

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.

Crohn’s disease is a chronic inflammatory condition of the human gastrointestinal tract of undetermined etiology. It is characterized by a relapsing and remitting course and by significant morbidity from chronic abdominal pain, diarrhea, and perianal abscesses.

Image: Histopathology of Patient with Crohn\'s disease showing evidence of an epithelioid nonnecrotizing granuloma (Photo courtesy of Catherine E. Hagen, MD and Luisa Ricaurte Archila, MD)

Gastroenterologists at the Royal Brisbane and Women’s Hospital (Brisbane, Australia) and their colleagues studied the correlation between longitudinal laboratory testing and subsequent intestinal complications in 246 patients with Crohn’s disease. This was 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.

The team analyzed C-reactive protein (CRP, (mg/L), erythrocyte sedimentation rate (ESR, mm/h), hemoglobin level (g/L), mean cell volume (MCV, fL), white blood cell count (WCC, × 109/L), platelet count (× 109/L), neutrophil count (× 109/L), fecal calprotectin (mcg/g feces), ferritin (mcg/L), alanine transferase (ALT, IU/L), and albumin (g/L).

The scientists reported that n 246 patients they 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. A Longitudinal Laboratory score ≥ 2 predicted the development of a future complication, with a positive predictive value of 84%, and a negative predictive value of 76%.

The authors concluded that consistently reduced serum albumin and MCV, and consistently increased CRP and platelet count are associated with future development of complications in patients with Crohn’s disease. These laboratory changes are observed up to two years prior to the development of a complication. In addition to recognized markers of poor outcome in Crohn’s disease, longitudinal laboratory tests may be assessed and used to provide a rationale for timely escalation of therapy. The study was published on September 20 2022 in the journal Digestive Diseases and Sciences.

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