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* = Presenting author

P426 Disease phenotype, activity, and clinical course based on the C-reactive protein level at diagnosis in Crohn's Disease: results from the CONNECT study

J.H. Kwon*1, J.P. Im1, J.S. Kim1, J.H. Cheon2, W.H. Kim2, Y.S. Kim3, B.D. Ye4, K.M. Lee5, Y.H. Kim6, D.S. Han7

1Seoul National University College of Medicine, Department of Internal Medicine and Liver Research Institute, Seoul, Korea, Republic of, 2Yonsei University College of Medicine, Department of Internal Medicine and Institute of Gastroenterology, Seoul, Korea, Republic of, 3Inje University College of Medicine, Department of Internal Medicine, Seoul, Korea, Republic of, 4Asan Medical Center,University of Ulsan College of Medicine, Department of Internal Medicine, Seoul, Korea, Republic of, 5Catholic University College of Medicine, Saint Vincent Hospital, Department of Internal Medicine, Suwon, Korea, Republic of, 6Sungkyunkwan University School of Medicine, Department of Internal Medicine, Seoul, Korea, Republic of, 7Hanyang University Guri Hospital, Department of Internal Medicine, Guri, Korea, Republic of

Background

C-reactive protein (CRP) is a surrogate marker of acute inflammation in Crohn's disease (CD). Disease course of CD is unpredictable and clinical manifestation of is heterogeneous with phenotypic change over time. Although several clinical factors, serologic, and genetic biomarkers may be used for the prediction of clinical course, definite prognostic factor has not been established. CRP is easily measurable noninvasive marker to evaluate disease activity, but there's controversy about the role for prediction of clinical course. Therefore, we designed a study to investigate whether CRP level at diagnosis is valuable for identification of disease phenotype, activity, and clinical course in CD.

Methods

We retrospectively analyzed 705 CD patients with measurable CRP level who were enrolled into Crohn's Disease Clinical Network and Cohort (CONNECT) study from 32 institutions. Those patients divided into CRP more than 20 or CRP less than 20 mg/L at diagnosis. Patient's demographic, clinical characteristics and use of immunosuppressive or biological agents were investigated. Disease location, behavior, hospitalization, and surgery were also analyzed based on the CRP. Logistic regression analysis was performed to evaluate predictive factor affecting hospitalization.

Results

Of 705 CD patients, 52.9% had CRP more than 20 mg/L at diagnosis. High CRP was associated with younger age at diagnosis, use of steroid at diagnosis, colonic or ileocolonic location, high score of CDAI, and active inflammation at colonoscopy (P<0.001, <0.001, <0.001, 0.001, and <0.001 respectively). In disease progress, patients with high CRP were found to have more stricturing feature (P=0.027). There were significant differences in use of 5-aminosalicylic acid, antibiotics, corticosteroid, azathioprine, and infliximab (P<0.001, < 0.001, <0.001, <0.001, and 0.023 respectively). Hospitalization was also higher in patients with high CRP.

Conclusion

Disease classification by CRP level at diagnosis is useful for evaluating disease phenotype, activity, and clinical course in CD. Strict follow-up strategy with early aggressive treatment could be considered in patients with high CRP.