P5 Risk factors associated with intestinal failure in crohn’s disease patients: a retrospective cohort study

Abstract

<h3>Introduction</h3> Intestinal failure (IF) is a serious complication of Crohn’s disease (CD) associated with significant morbidity and mortality. However, its risk factors remain poorly characterised. To better characterise these factors, we provide data from one of largest retrospective studies at a tertiary IBD center. <h3>Methods</h3> All adult patients diagnosed with CD referred to the IF service between January 2016 and October 2019 were screened. To identify risk factors, demographic and CD characteristics, surgical characteristics, and medical management were analysed. The primary outcome was the duration of time between CD diagnosis and IF. Secondary outcomes included duration on parenteral nutrition. Statistical analysis was performed in SPSS (Version 26) with results reported as mean ± standard deviation. Statistical tests included an unpaired t-test and one way ANOVA with Tukey’s post-hoc analysis. <h3>Results</h3> 56 CD patients referred to the IF service were recruited to the study. The mean age at CD diagnosis and at analysis was 24.8 years ± 13.5 and 50.0 years ± 16.2 respectively. The cohort was predominantly female (57.1%) and had a smoking history (63.0%), with a mean time to IF of 19.0 years ± 13.7 and a median time on parenteral nutrition of 55.0 months (Figure 1). The mean small bowel length remaining was 118.0 cm ± 53.6, the mean number of intestinal resections were 2.9 ± 1.8, and 12.5% had a colon remnant. An initial diagnosis of Type 2 IF was associated with a shorter time to IF than Type 3 IF (15.0 years vs. 23.0 years, P=0.042) (Figure 1). Presence of a family history of IBD did not significantly influence time to IF (15.0 years vs. 19.0 years, P=0.267), but an older age at CD diagnosis (6.0 years vs. 21.0 years, P=0.063) and history of multiple biologics (11.0 years vs. 25.0 years, P=0.057) trended towards decreasing the time to IF (Figure 1). Compared to an internal fistula, presence of an external fistula was associated with a significant reduction in mean disease duration to IF (14.1 years vs. 29.8 yrs, P=0.01) (Figure 1). Similarly, involvement of the upper gastrointestinal tract significantly decreased the time diagnosis to IF (10.4 years vs. 20.6 years, P=0.045) (Figure 1). <h3>Conclusions</h3> A multitude of demographic, medical and surgical factors are associated with the development of IF. Presence of an internal fistula, upper gastrointestinal disease, history of multiple biologics, and an acute presentation could be more predictive of a reduced time to IF.