Disease Phenotype, Activity and Clinical Course Prediction Based on C-Reactive Protein Levels at Diagnosis in Patients with Crohn’s Disease: Results from the CONNECT Study
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: C-reactive protein (CRP) is an easily measured index of disease activity, but its ability to predict clinical course is controversial. We therefore designed a study to determine whether the CRP level at Crohn’s disease (CD) diagnosis is a valuable indicator of the disease phenotype, activity, and clinical course. Methods: We retrospectively analyzed 705 CD patients from 32 institutions. The patients were classified into two groups according to CRP level. The patients’ demographic and clinical characteristics and their use of immunosuppressive or biological agents were recorded. Disease location and behavior, hospitalization, and surgery were analyzed. Results: A high CRP was associated with younger age, steroid use, colonic or ileocolonic location, high CD activity index, and active inflammation at colonoscopy (p<0.001). As the disease progressed, patients with high CRP were more likely to exhibit strictures (p=0.027). There were significant differences in the use of 5-aminosalicylic acid, antibiotics, corticosteroids, azathioprine, and infliximab (p<0.001, p<0.001, p<0.001, p<0.001, and p=0.023, respectively). Hospitalization was also more frequent in patients with high CRP. Conclusions: The CRP level at diagnosis is useful for evaluating the phenotype, activity, and clinical course of CD. Closer follow-up strategies, with early aggressive treatment, could be considered for patients with high CRP.
Abstract
Background/Aims: C-reactive protein (CRP) is an easily measured index of disease activity, but its ability to predict clinical course is controversial. We therefore designed a study to determine whether the CRP level at Crohn’s disease (CD) diagnosis is a valuable indicator of the disease phenotype, activity, and clinical course. Methods: We retrospectively analyzed 705 CD patients from 32 institutions. The patients were classified into two groups according to CRP level. The patients’ demographic and clinical characteristics and their use of immunosuppressive or biological agents were recorded. Disease location and behavior, hospitalization, and surgery were analyzed. Results: A high CRP was associated with younger age, steroid use, colonic or ileocolonic location, high CD activity index, and active inflammation at colonoscopy (p<0.001). As the disease progressed, patients with high CRP were more likely to exhibit strictures (p=0.027). There were significant differences in the use of 5-aminosalicylic acid, antibiotics, corticosteroids, azathioprine, and infliximab (p<0.001, p<0.001, p<0.001, p<0.001, and p=0.023, respectively). Hospitalization was also more frequent in patients with high CRP. Conclusions: The CRP level at diagnosis is useful for evaluating the phenotype, activity, and clinical course of CD. Closer follow-up strategies, with early aggressive treatment, could be considered for patients with high CRP.
참고문헌 (33)
- Mazor Y, "Prediction of disease complication occurrence in Crohn’s disease using phenotype and genotype parameters at diagnosis", J Crohns Colitis, 5, pp.592~597 (2011)
- 정윤숙, "Seasonal Variation in Months of Birth and Symptom Flares in Korean Patients with Inflammatory Bowel Disease", Gut and Liver, 7(6), pp.661~667 (2013), 거트앤리버 발행위원회
- Chen-Wang Chang, "Intestinal Stricture in Crohn’s Disease", Intestinal research, 13(1), pp.19~26 (2015), 대한장연구학회[DOI]
- Pin-Jin Hu, "Inflammatory Bowel Disease in Asia: The Challenges and Opportunities", Intestinal research, 13(3), pp.188~190 (2015), 대한장연구학회
- Paulo Gustavo Kotze, "Conventional Versus Biological Therapy for Prevention of Postoperative Endoscopic Recurrence in Patients With Crohn’s Disease: an International, Multicenter, and Observational Study", Intestinal research, 13(3), pp.259~265 (2015), 대한장연구학회
- D’Incà R, "Can calprotectin predict relapse risk in inflammatory bowel disease?", Am J Gastroenterol, 103, pp.2007~2014 (2008)
- Cotterill L, "Replication and meta-analysis of 13,000 cases defines the risk for interleukin-23 receptor and autophagy-related 16-like 1 variants in Crohn’s disease", Can J Gastroenterol, 24, pp.297~302 (2010)
- Lichtenstein GR, "Emerging prognostic markers to determine Crohn’s disease natural history and improve management strategies:a review of recent literature", Gastroenterol Hepatol, 6, pp.99~107 (2010)
- Van Limbergen J, "The genetics of inflammatory bowel disease", Am J Gastroenterol, 102, pp.2820~2831 (2007)
- 이강문, "Fecal Biomarkers in Inflammatory Bowel Disease", Intestinal research, 11(2), pp.73~78 (2013), 대한장연구학회
- Vermeire S, "C-reactive protein as a marker for inflammatory bowel disease", Inflamm Bowel Dis, 10, pp.661~665 (2004)
- Jürgens M, "Levels of Creactive protein are associated with response to infliximab therapy in patients with Crohn’s disease", Clin Gastroenterol Hepatol, 9(e1), pp.421~427 (2011)
- Mendall MA, "C-reactive protein:relation to total mortality, cardiovascular mortality and cardiovascular risk factors in men", Eur Heart J, 21, pp.1584~1590 (2000)
- Imhof A, "Effect of alcohol consumption on systemic markers of inflammation", Lancet, 357, pp.763~767 (2001)
- Vermeire S, "Laboratory markers in IBD: useful, magic, or unnecessary toys?", Gut, 55, pp.426~431 (2006)
- Solem CA, "Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease", Inflamm Bowel Dis, 11, pp.707~712 (2005)
- Cellier C, "Correlations between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn’s disease: a prospective multicentre study of 121 cases. The Groupe d’Etudes Thérapeutiques des Affections Inflammatoires Digestives", Gut, 35, pp.231~235 (1994)
- Lakatos PL, "Serum lipopolysaccharidebinding protein and soluble CD14 are markers of disease activity in patients with Crohn’s disease", Inflamm Bowel Dis, 17, pp.767~777 (2011)
- Koelewijn CL, "C-reactive protein levels during a relapse of Crohn’s disease are associated with the clinical course of the disease", World J Gastroenterol, 14, pp.85~89 (2008)
- Magro F, "High Creactive protein in Crohn’s disease patients predicts nonresponse to infliximab treatment", J Crohns Colitis, 8, pp.129~136 (2014)
- 천재희, "Crohn’s Disease Clinical Network and Cohort (CONNECT) Study: The First Step Toward Nationwide Multicenter Research of Crohn’s Disease in Korea", Intestinal research, 12(3), pp.173~175 (2014), 대한장연구학회
- Jung Won Lee, "Inflammatory Bowel Disease Cohort Studies in Korea: Present and Future", Intestinal research, 13(3), pp.213~218 (2015), 대한장연구학회
- Carter MJ, "Guidelines for the management of inflammatory bowel disease in adults", Gut, 53(5), pp.V1~V16 (2004)
- Bernstein CN, "Hospitalisations and surgery in Crohn’s disease", Gut, 61, pp.622~629 (2012)
- Kiss LS, "High-sensitivity C-reactive protein for identification of disease phenotype, active disease, and clinical relapses in Crohn’s disease: a marker for patient classification?", Inflamm Bowel Dis, 18, pp.1647~1654 (2012)
- Florin TH, "Clinically active Crohn’s disease in the presence of a low C-reactive protein", Scand J Gastroenterol, 41, pp.306~311 (2006)
- Thalmaier D, "The +1059G", C polymorphism in the C-reactive protein (CRP) gene is associated with involvement of the terminal ileum and decreased serum CRP levels in patients with Crohn’s disease, 2006, pp.24, 1105~1115
- 양동훈, "Usefulness of C-Reactive Protein as a Disease Activity Marker in Crohn’s Disease according to the Location of Disease", Gut and Liver, 9(1), pp.80~86 (2015), 거트앤리버 발행위원회
- Peyrin-Biroulet L, "Mesenteric fat as a source of C reactive protein and as a target for bacterial translocation in Crohn’s disease", Gut, 61, pp.78~85 (2012)
- Peyrin-Biroulet L, "Mesenteric fat in Crohn’s disease: a pathogenetic hallmark or an innocent bystander?", Gut, 56, pp.577~583 (2007)
- Consigny Y, "A simple biological score for predicting low risk of short-term relapse in Crohn’s disease", Inflamm Bowel Dis, 12, pp.551~557 (2006)
- Chamouard P, "Diagnostic value of C-reactive protein for predicting activity level of Crohn’s disease", Clin Gastroenterol Hepatol, 4, pp.882~887 (2006)
- Treton X, "Azathioprine withdrawal in patients with Crohn’s disease maintained on prolonged remission:a high risk of relapse", Clin Gastroenterol Hepatol, 7, pp.80~85 (2009)