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P075. Evolutive profile of biomarkers in postoperative Crohn's disease patients: identification of recurrence risk predictors

E. Cerrillo1, I. Moret2, M. Iborra3, F. Rausell2, L. Tortosa2, G. Bastida3, M. Aguas3, G. Sánchez4, P. Nos3, B. Beltrán3, 1IIS La Fe University Hospital, Valencia, Spain, 2IIS La Fe University Hospital/CIBEREHD, Valencia, Spain, 3Gastroenterology Unit, La Fe University Hospital/CIBEREHD, Valencia, Spain, 4Radiology Unit, La Fe University Hospital, Valencia, Spain

Background

A high percentage of Crohn's disease (CD) patients require surgery. However, postoperative recurrence remains a problem. The ability to assess or even predict recurrence is complicated. Biomarkers as fecal calprotectin (FC) and serum cytokines appear promising, but further investigation to identify the potential use and cut-off values are needed. Aim: To identify the predictor biomarkers of recurrence in CD patients that underwent surgery.

Methods

A cohort of 30 CD patients who underwent a resection was prospectively followed for 24 months. Stool for FC, and blood samples for CRP (mg/L) and cytokines (pg/mL) determination were obtained before and after surgery (with measurements every 3 months). Plasma cytokines (IL1beta, IL2, IL6, IL10, IL12, IL13, TNFalpha and IFNgamma) were quantified by Luminex® xMap technology. FC was determined by ELISA (µg/g). Following the clinical practice, morphological recurrence was assessed by ileocolonoscopy or MRI enterography within 6–12 months after surgery, and simultaneously, FC was analyzed in nonrecurred patients to settle the cut-off value. Measurements compared patients with and without recurrence. Statistical analysis was performed by Cox survival models to study the hazard of recurrence for each variant.

Results

In the first year after surgery, twenty-one patients (70%, 44±6 y/o) have not recurred whereas 9 have recurred (30%, 47±4 y/o). This percentage increased to 47% in the subsequent year. Presurgery levels of IL13 differentiated patients that later developed recurrence (see table). Other significant values are depicted in the table. The cut-off FC value, obtained from non recurred, was 200 µg/g. At 6 months, FC was 456±152 µg/g in recurred patients. Although not significant, this value showed the FC tendency, that resulted in statistically differences by 9 months. At that time, CRP did not identify recurrence.

 IL13IL1 βIL2IL10IFN γFC
 presurgery6 months6 months6 months6 months9 months
Recu25±721±617±550±1749±15380±144
Non recu10±313±49±335±1021±6120±45
P0.0030.010.010.030.020.03
Values are mean±SEM.

Conclusion

IL13 could be a powerful biomarker to predict recurrence before patients undergo surgery. Postoperative levels of IL1b, IL2, IL10 and IFNg by 6 months could also predict recurrence. A FC cut-off of 200 µg/g allows discriminating recurrence. FC identify recurrence by 6 months, through starts being significant by 9 months. We are now developing risk estimation tools for presurgery and/or 6 months postsurgery evaluation.