P238. Serum CRP level and loss of infliximab response in early phase can be markers for abdominal abscess for Crohn's disease; a report by multivariate study
K. Yoneno1, T. Hisamatsu1, K. Matsuoka1, S. Okamoto1, T. Takayama1, R. Ichikawa1, T. Sujino1, J. Miyoshi1, Y. Mikami1, T. Yajima1, N. Inoue2, Y. Iwao2, T. Kanai1, H. Ogata2, T. Hibi1
1Keio University School of Medicine, Division of Gastroenterology & Hepatology, Department of Internal Medicine, Tokyo, Japan; 2Keio University School of Medicine, Center for Diagnostic and Therapeutic Endoscopy, Tokyo, Japan
Background: Infliximab (IFX) gives new strategy and beneficial effect to treatment for Crohn's disease. Abscess formation is well known as the major complication of Crohn's disease, but there are few reports which studied the characteristics in IFX treatment. In the present study, we show the patients' characteristics to increase the risk of abscess formation during the IFX maintenance therapy for Crohn's disease.
Methods: 258 patients with Crohn's disease who underwent IFX therapy from 2000 to April 2011 at our hospital were evaluated as a retrospective study. We studied the risk factors of abscess formation by medical records that include blood examination (at the points of 0 week and 14 weeks after the IFX induction therapy), medical imaging and clinical course. As statistical analyses, we tested multivariate logistic regression after checking some single variable analyses to compare abscess group with non-abscess group. We also analyzed the prognosis of the patients complicated with abscess formation.
Results: All abscess cases were 15 (5.8%) in 258 patients treated with IFX. Compared the abscess cases with the others, that exclude 5 episodic administration cases, serum CRP level of 14 weeks was higher (Mann-Whitney U test, 2.27 mg/dl vs 0.10 mg/dl: median, P = 0.021) and serum albumin level of 0 and 14 weeks were lower (Mann-Whitney U test, 3.3 mg/dl vs 3.7 mg/dl, P = 0.022. 3.7 mg/dl vs 4.1 mg/dl, P = 0.004) in the patients complicated with abscess. We also found anal lesion (chi-square test, P = 0.036) and loss of IFX response in early phase (logrank test, P < 0.0001) were risk factors as independent variables. On the basis of single variable analyses, we found CRP level of 14 weeks (OR 1.355, 95%CI 1.0361.773) and loss of IFX response within 6 months (OR 5.004, 95%CI 1.05923.640) were risk factors of abdominal abscess by multivariate logistic regression. In 15 abscess cases, 13/15 cases (86.7%) had stenosis lesion when abscess was developed. For abscess therapy, 11/15 cases (73.3%) went through an operation, the others 3 cases were received a noninvasive treatment (1 case was unknown). After these therapies, 8/11 operation cases (72.7%) were able to receive maintenance IFX therapy every 8 weeks again but 3/3 (100.0%) noninvasive treatment cases were not.
Conclusions: We should carefully rule out the abscess formation during IFX maintenance therapy, especially in the patients with uncontrollable CRP level at 14 weeks and loss of IFX response in early phase.