Abstract
BackgroundMarkers that predict the occurrence of a complicated disease behavior in patients with Crohn's disease (CD) can permit a more aggressive therapeutic regimen for patients at risk. The aim of this cohort study was to test the blood levels of hemoglobin (Hgb) and hematocrit (Hct) for the prediction of complicated CD behavior and CD related surgery in an adult patient population.MethodsBlood samples of 62 CD patients of the German Inflammatory Bowel Disease-network “Kompetenznetz CED” were tested for the levels of Hgb and Hct prior to the occurrence of complicated disease behavior or CD related surgery. The relation of these markers and clinical events was studied using Kaplan-Meier survival analysis and adjusted COX-proportional hazard regression models.ResultsThe median follow-up time was 55.8 months. Of the 62 CD patients without any previous complication or surgery 34% developed a complication and/or underwent CD related surgery. Low Hgb or Hct levels were independent predictors of a shorter time to occurrence of the first complication or CD related surgery. This was true for early as well as late occurring complications. Stable low Hgb or Hct during serial follow-up measurements had a higher frequency of complications compared to patients with a stable normal Hgb or Hct, respectively.ConclusionsDetermination of Hgb or Hct in complication and surgery naïve CD patients might serve as an additional tool for the prediction of complicated disease behavior.
Highlights
Crohn’s disease (CD) is frequently characterized by the occurrence of a complicated disease behavior, defined as fistulae or stenoses, and the need for CD related surgery
Serological markers directed against microbial peptides and linked to CD, such as anti-Saccharomyces cervisiae (ASCA) and others have been extensively investigated for disease stratification and association [4,5,6]
The median time from diagnosis to study entry was 16.5 months (25th percentile (P25) 1.8 months; 75th percentile (P75) 50.4 months) with 38.7% of the samples procured within 6 months and 50% within one year of diagnosis of CD
Summary
Crohn’s disease (CD) is frequently characterized by the occurrence of a complicated disease behavior, defined as fistulae or stenoses, and the need for CD related surgery. While red cell parameters have been linked to IBD activity [10,11,12], comparably little attention has been given to hemoglobin (Hgb) or hematocrit (Hct) for disease course prediction. An exploration of these markers is warranted as one could speculate that more severe disease or tissue damage is likely to be linked to anemia. Markers that predict the occurrence of a complicated disease behavior in patients with Crohn’s disease (CD) can permit a more aggressive therapeutic regimen for patients at risk The aim of this cohort study was to test the blood levels of hemoglobin (Hgb) and hematocrit (Hct) for the prediction of complicated CD behavior and CD related surgery in an adult patient population
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