P259. Disabling Crohn's disease: frequency and predictive factors in hospitalized patients
M. Serghini1, S. Karoui1, N. Ben Mustapha1, M. Fekih1, L. Kallel1, S. Matri1, J. Boubaker1, A. Filali1, 1University ElManar, Faculty of Medecine of Tunis, Gastroenterology A, La Rabta Hospital, Tunis, Tunisia
In the era of biological treatment of Crohn's disease, the top-down strategy should be considered only in patients with severe course or those having a disabling Crohn's disease as defined by Beaugerie et al. in 2006.
The aim of our study was to specify in a population of hospitalized patients, the frequency of disabling Crohn's disease and to identify at diagnosis the predictive factors of this disabling course.
We conducted a retrospective study and we considered for inclusion all the patients with Crohn's disease diagnosed and hospitalized at our unit between January 2005 and December 2009. For each patient we have specified the clinical, biological, endoscopic and evolutive data.
During the period of the study, 201 patients with CD were included (106 males, 95 females) with the median age at diagnosis of 33.6 years [14–65]. The median follow up was of 28.3 months [6–168]. The prevalence of disabling CD during the follow up period was 75% (151 patients). By multivariate analysis, the factors present at diagnosis and significantly associated with a disabling course of the CD after diagnosis were: an age below 16 years (p = 0.03; OR = 2.7 [95% CI 1–7.8]), the initial localization of the disease restricted to the ileum (p = 0.02; OR = 3 [95% CI 1.1–7.9]), a penetrating behavior (p = 0.03; OR = 2.7 [95% CI 1–7.8]), a leucocytes level higher than 8300/mm3 (p = 0.003; OR = 4 [95% CI 1.6–9.8]) and an albumin level below 35.8 g/l (p = 0.05; OR = 2.4 [95% CI 0.9–6.2]). The presence of 4 or 5 of these factors predicted a disabling course of CD with a predictive positive value of 0.93 and 0.95 respectively.
A disabling CD was observed in 75% of patients during the follow up period of the study. The identification of the predictive factors of this disabling course must be considered at diagnosis in order to adjust therapeutic strategy.