Poorer clinical outcomes are observed in Crohnʼs disease patients with higher serological assay values

Abstract

To evaluate the association between serological markers and clinical outcomes of Crohn's disease (CD) patients We performed a retrospective study of patients who were referred to University of California Davis outpatient Gastroenterology clinic between 2000 to 2007 and had serological markers performed. The first encounter for initial referral was considered to be the index for date of follow-up. Clinical information was collected by chart review of all clinic visit, emergency room visits, hospitalizations, and operative reports. Patients were given the diagnosis of CD by radiology, endoscopic, and histological evidence. Escalation of therapy was defined as the need to add additional therapies, such as an immunomodulator and/or biologic, at a follow-up encounter. The Prometheus IBD serology report (Prometheus Labs, San Diego, CA) provides assay values for antibodies to Saccharomyces cerevisiae (ASCA IgA and IgG), antibodies to the outer membrane porin C of Escherichia coli (OmpC), antibodies to bacterial flagellin (CBir1), and IBD specific perinuclear antineutrophilic autoantibodies (pANCA). Two hundred and eighteen patients fulfilled study criteria. Of these, 64 patients were given a clinical diagnosis of CD. Average length of follow up was 19 months. The extent of disease involvement and any CD related complications are reported in Table 1. The average serological assay values were higher in CD patients with complications compared to those without complications (Table 2). Disease Extent and Complication Rates Disease Extent and Complication Rates Average Serology Antibody Assay Values Based on Complications Average Serology Antibody Assay Values Based on Complications We report the distribution of disease extent and complication rates among our CD patients, 37.5% required surgical intervention, 26.6% had fistulizing disease, and 17.2% had stenosing disease. We observed higher serology antibody values in CD patients that had complicated disease. This suggests that serological markers may be a useful tool to help identify patients with more severe disease.