C-reactive protein levels in the perioperative period as a predictive marker of endoscopic recurrence after ileo-colonic resection for Crohn's disease.

E Iaculli,C Fiorani,A Manzelli,Gs Sica,M Agostini,F Montagnese,L Biancone,A Rufini,M Tesauro,A Di Vizia,S Sibio

doi:10.1038/cddiscovery.2016.32

E Iaculli, C Fiorani + Show 9 more

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https://doi.org/10.1038/cddiscovery.2016.32

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Abstract

The aim of this study was to determine the perioperative behavior of C-reactive protein (CRP) in Crohn’s disease (CD) patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Study hypothesis was that perioperative CRP changes are disease specific and could detect subset of patients with more aggressive pathopysiology. Seventy-five patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed: preoperative, postoperative day 1 (POD1) and day 5 (POD5). CD patients’ values were compared against same interval assessments of control groups undergoing right colectomy and appendicectomy. At POD1, the serum concentration increase was significantly higher in CD patients than in controls. Comparing with control groups, CRP levels remained remarkably high and showed a lower reduction in CD at POD5. Difference between groups was statistically significant. Optimal cutoff levels have been identified: serum CRP concentrations of >39.8 mg/l at POD1 and of >23.2 mg/l at POD5 have shown a significant association to endoscopic recurrence when using bivariate correlation. In this preliminary series, binary logistic regression could not demonstrate statistical relationship between endoscopic recurrence and any of the variables evaluated as prognostic factor. This is the only study so far that investigates and confirms a disease-specific upregulation of CRP response in the perioperative period for CD patients undergoing surgery. The postoperative CRP levels and kinetics seem to be related to the grade of mucosal inflammation and recurrence rate according to our 12 months endoscopic evaluation.

Highlights

Inflammatory bowel disease (IBD) consists of two major disorders, Crohn's disease (CD) and ulcerative colitis.[1,2] the etiology of IBD is still largely unknown, evidence in many studies indicates that individual’s genetic susceptibility,[3,4] external environment, intestinal microbial flora and immune responses are all involved in the pathogenesis of IBD
This study aims to identify association between perioperative C-reactive protein (CRP) levels in patients undergoing elective ileo-cecal (IC) resection for CD and endoscopic recurrence in a 12-month follow-up
We suggest that the degree of immunologic changes and related severity of disease might be explored immediately soon after surgery by determining perioperative CRP modification

Summary

Introduction

Inflammatory bowel disease (IBD) consists of two major disorders, Crohn's disease (CD) and ulcerative colitis.[1,2] the etiology of IBD is still largely unknown, evidence in many studies indicates that individual’s genetic susceptibility,[3,4] external environment, intestinal microbial flora and immune responses are all involved in the pathogenesis of IBD. Genetic researches have shown that autophagy, an essential biological process,[5,6] in immune responses has an indispensable role in IBD. Two autophagy-related genes named ATG16L1 and IRGM have been reported to be mutated in IBD.[7] In addition, more recently, small non-coding RNAs (microRNAs),[8] which have an important role in several biological[9,10,11,12] and pathological processes,[13,14] are novel players in IBD.[15,16]. Up to 70–90% of patients show endoscopic recurrence at 1 year.[18,19]

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