Silent Crohn's Disease: Asymptomatic Patients with Elevated C-reactive Protein Are at Risk for Subsequent Hospitalization. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Click, Benjamin; Vargas, Eric J.; Anderson, Alyce M.; Proksell, Siobhan; Koutroubakis, Ioannis E.; Ramos Rivers, Claudia; Hashash, Jana G.; Regueiro, Miguel; Watson, Andrew; Dunn, Michael A.; Schwartz, Marc; Swoger, Jason; Baidoo, Leonard; Barrie, Arthur; Binion, David G.
• Is Part Of: Inflammatory bowel diseases. Volume 21:Issue 10(2015:Oct.)
• Publication Date: 2015-10
• Subjects: Crohn's disease -- C-reactive protein -- disease monitoring -- hospitalization; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/MIB.0000000000000516
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : 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. Abstract : Article first published online 20 July 2015.Supplemental Digital Content is Available in the Text.