Abstract
Intestinal inflammation and mucosal damage in Crohn’s disease (CD) are believed to progress even during clinical remission. We investigated the long-term prognosis of CD patients in clinical remission according to serum C-reactive protein (CRP) levels. This study included 339 CD patients in clinical remission (Crohn’s disease activity index < 150) for more than 6 months between January 2008 and December 2010. Clinical outcomes were compared between patients with normal and elevated CRP levels during clinical remission. During clinical remission, 150 patients had normal CRP consistently and 189 had elevated CRP at least once. During follow-up (median, 7.9 years [interquartile range, 6.8–8.0]), the Kaplan–Meier analysis with the log-rank test showed that normal CRP group had a longer CD-related hospitalization-free survival (P = 0.007) and a longer CD-related intestinal resection-free survival (P = 0.046) than elevated CRP group. In multivariate analysis, elevated CRP was significantly and independently associated with an increased risk of subsequent CD-related hospitalization (adjusted hazard ratio [aHR] 1.787, 95% confidence interval [CI]: 1.245–2.565, P = 0.002) and of subsequent CD-related intestinal resection (aHR 1.726, 95% CI: 1.003–2.969, P = 0.049). The most common reason for CD-related hospitalization was penetrating complications (35.6%). Even when CD patients are in clinical remission, elevated CRP is significantly associated with subsequent CD-related hospitalization and CD-related intestinal resection during follow-up. CD patients in clinical remission but elevated CRP should receive more careful attention and timely interventions to improve long-term outcomes.
Highlights
Crohn’s disease (CD) is among the major types of inflammatory bowel diseases (IBD) that affect the whole gastrointestinal tract, and its global incidence and prevalence are increasing [1,2,3]
We found no significant differences in age, sex, smoking status, family history of IBD, Montreal location and behavior of CD, extraintestinal manifestations, medications used, or history of bowel or perianal surgery between the elevated C-reactive protein (CRP) group (n = 189) and the normal CRP group (n = 150; Table 1)
During the follow-up period, more patients with elevated CRP levels were hospitalized than patients with normal CRP
Summary
Crohn’s disease (CD) is among the major types of inflammatory bowel diseases (IBD) that affect the whole gastrointestinal tract, and its global incidence and prevalence are increasing [1,2,3]. Most patients with CD experience a waxing and waning clinical course of relapse and remission and develop cumulative structural damage to the bowel over time [4]. The Crohn’s disease activity index (CDAI), which is based primarily on subjective symptoms, has been widely used in the medical management of CD [6]. CDAI scores reportedly have poor correlation with both inflammatory biomarkers such as C-reactive protein (CRP) and endoscopic disease activity [7,8,9]. There may be a subgroup of CD patients who despite being in clinical remission, have a high burden of bowel inflammation and a high probability of progressive bowel damage
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