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DOP048. Is hospitalization predicting the disease course in Crohn's disease? Prevalence and predictors of hospitalization and re-hospitalization in Crohn's disease in a population based inception cohort between 2000–2012

P.A. Golovics1, M. Mandel1, B. Lovasz1, Z. Vegh1, I. Szita2, L. Kiss1, M. Balogh3, A. Mohas1, B. Szilagyi1, T. Pandur2, L. Lakatos2, P. Lakatos1, 1Semmelweis University, 1st Department of Medicine, Budapest, Hungary, 2Csolnoky F. Province Hospital, Department of Medicine, Veszprem, Hungary, 3Grof Eszterhazy Hospital, Department of Medicine, Papa, Hungary

Background

Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in a population based inception cohort in the Veszprem province database between 2000 and 2012.

Methods

Data of 304 incident CD patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (mean age at diagnosis: 32.2; SD: 15.4years). Both in- and outpatient records were collected and comprehensively reviewed.

Results

Probabilities of first hospitalization and first re-hospitalization were 54.9%, 72% 76% and 22.8%, 34%, 52.3% after 1, 2 and 5 years of follow-up in Kaplan–Meier analysis. Main reasons for hospitalization in the first year were diagnostic procedures (48.5%), IBD related surgery (29.9%) and disease activity (14.3%). Non-inflammatory disease behavior at diagnosis (HR: 1.41, 95% CI: 1.41–1.89, p = 0.02) was the only factor significantly associated with time to hospitalization while both non-inflammatory disease behavior at diagnosis (HR: 1.92, 95% CI: 1.35–2.74, p < 0.001) and disease behavior change (HR: 1.89, 95% CI: 1.27–2.81, p = 0.002) were associated with time to first re-hospitalization in multiple Cox-regression analysis. Early hospitalization (within the year of diagnosis) was associated with age at onset (p = 0.002), non-inflammatory disease behavior at diagnosis (OR: 2.67, p < 0.001), internal fistulizing disease (OR: 2.02, p = 0.04) and it was predictive for need for immunosuppressives (OR: 1.74, p = 0.018) and need for surgery/multiple surgeries (OR: 2.63, p = 0.018 and OR: 2.54, p = 0.005) during the disease course.

Conclusion

Early hospitalization was associated with clinically significant outcomes (need for immunosuppressives and surgery). Hospitalization and re-hospitalization rates are still high in this population-based cohort. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factors for both hospitalization and re-hospitalization.