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P131. The lack of CRP response in patients with non-colonic active Crohn's disease

M. Crnčević Urek1, M. Banić1, M. Kujundžić1, L. Petričušić1, D. Kardum1, V. Hulak-Karlak1, S. Pleško2

1University Hospital Dubrava, Zagreb, Croatia; 2University Hospital Zagreb, Zagreb, Croatia

Aims: The C-reactive protein (CRP) is standard laboratory parameter of the acute phase response of inflammation in Crohn's disease (CD) and broadly correlates with disease activity. However, 20–25% of CD patients will not increase a CRP level in the case of active inflammation from until now uknown reasons, although previous abdominal surgery, older age and unexplained anaemia are recognized as potential predictors of the low CRP response. In this study we investigated the characteristics of CRP response in 31 hospitalized patients who suffered at least two exacerbations of CD.

Methods: We analysed the association of CRP reactivity with localisation of CD (colonic and non-colonic disease), age, haemoglobin level, serum iron concentration, and previous abdominal surgery as a parameters with potential effect on CRP response. Colonic disease (COL) included patients with ileocolitis and Crohn colitis, while the group of non-colonic patients (NCOL) included patients with small bowel disease, perianal disease and involvement of upper digestive tract. The exacerbations were defined as a CDAI > 150 with an increase of >100 points from baseline. CRP responders were defined as patients with CRP value >20 mg/l in both exacerbations.

Results: The median age of patients was 41 yrs (range 22–68 yrs); 23 patients belonged to the group of CRP reactors (75%), 8 patients were CRP non-reactors (25%). Regarding localisation of disease significantly higher number of CRP reactor patients belonged to COL (17 pts; 73.91% vs NCOL 6 pts, 26.09%). In the CRP non-reactor group the majority of patients belonged to NCOL (2 pts COL, 25% vs 6 pts NCOL, 75%, p = 0.022; Fischer exact). There was no statisticaly significant difference between CRP reactor and non-reactor groups in the field of previous abdominal surgery (9 pts; 39.13% reactors vs 4 pts, 50% non-reactors, p = 0.974). CRP non-reactors belonged to a higher age group (CRP reactors: range 23 yrs-50 yrs, median 30 yrs, CRP non-reactors: range 22 yrs-68 yrs, median 41, p = 0.222 Mann Whitney, NS). CRP non-reactors had significantly lower serum iron concentrations (<10 g/L) than CRP-reactor group (p = 0.037; Fischer exact), meanwhile level of haemoglobin (cut off value 100 g/L) did not differ significantly between CRP reactor and non-reactor groups (p = 0.906).

Conclusion: In this study, the lack of CRP response during exacerbations of CD significantly correlated with non-colonic localisation of CD, older age, and lower serum iron concentrations; meanwhile previous abdominal surgery and the level of haemoglobin did not influenced CRP response.