S1056 Change in C-Reactive Protein 72 Hours Following Admission Associates With Inpatient and One-Year Colectomy Risk in Severe Ulcerative Colitis

Abstract

Introduction: Ulcerative colitis (UC) morbidity remains high despite multiple therapeutic advances. Early identification of risk for failure of medical therapies and need for colectomy becomes pivotal to avoid unnecessary and dangerous delays in care. Many presently-validated risk appraisal scores require subjective data to inform risk. Our study aimed to determine the predictive value of the change in C-reactive protein (CRP) during hospitalization for severe UC. Methods: We designed a retrospective study including patients ≥ 18 years old with an admission for UC at a single academic center between 1/1/2013 and 4/1/2018. Cases were identified using the ICD-9 code 556.X and ICD-10 code K51.X and separately, manually verified. Clinical variables of interest and laboratory values were obtained via chart review or extracted from the electronic medical record. Data was analyzed using Wilcoxon rank-sum test for continuous variables, and Fischer’s exact test for categorical variables. Statistical analysis was conducted using JMP ® 13.1.0. Results: 122 hospitalized patients met the inclusion criteria with a median age of 30.2 (IQR: 22.8-46.9) years. 72 (59%) patients were male and 89 (73.6%) were Caucasian. 27 (22.3%) patients required inpatient colectomy and 49 (41.5%) had a colectomy within one year of index admission. Percent change in CRP between admission and 72 hours was predictive of inpatient colectomy (P=0.051), whereas the value of CRP on admission or at 72 hours was not (Table). Among patients with an increase in CRP at 72 hours, 9/21 (42.9%) required inpatient colectomy as compared to 18/101 (17.8%) without an increase in CRP (P=0.019). The percent change in CRP at 72 hours was also predictive of 1-year colectomy risk (-53.3 (50.7) vs -33.7 (49.6), P=0.003). Conclusion: Percent change in CRP between admission and 72-hours predicts both inpatient and 1-year colectomy risk in patients hospitalized with UC. Percent change better prognosticates the need for surgery compared to CRP on admission alone. Herein, we show that a reduction in CRP by 50% 72 hours from admission is an objective and easily determined measurement to risk stratify patients early in the admission for UC. Table 1. - Predictors of colectomy during inpatient admission Risk Factors: Colectomy No Colectomy P-value Age (years), mean (SD) 37.98 (18.51) 35.08 (14.3) 0.644 Male Sex, n (%) 14 (51.85) 58 (61.05) 0.506 White Race, n (%) 21 (77.78) 68 (72.34) 0.631 Presentation with Severe Colitis, n (%) 27 (100) 82 (86.32) 0.07 Prior Admission requiring IV Steroids, n (%) 17 (62.96) 34 (35.79) 0.015 Hospitalization in prior 4 weeks, n (%) 23 (39.0%) 50 (24.5%) 0.047* Biologic naïve, n (%) 7 (25.93) 50 (52.63) 0.024 Single prior biologic class 12 (44.44) 33 (34.74) Multiple prior biologic classes 8 (29.63) 12 (12.63) Steroids usage prior to Presentation, n (%) 17 (62.96) 53 (55.79) 0.66 Inpatient salvage therapy 13 (48.15) 61 (64.21) < 0.001 Laboratory Data: Mean (SD) Admission CRP 45.7 (35.1) 52.89 (56.31) 0.7 72 hour CRP 37.41 (45.03) 26.52 (34.43) 0.178 72 hour change in CRP % -26.5 (58.74) -47.19 (55.81) 0.051