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* = Presenting author

P252 Elevated C-reactive protein level during clinical remission can predict poor outcomes in patients Crohn's disease

Oh K.*1, Oh E.H.1, Song E.M.2, Kim G.-U.2, Seo M.2, Hwang S.W.2,3, Park S.H.2,3, Yang D.-H.2, Kim K.-J.2,3, Byeon J.-S.2, Myung S.-J.2, Yang S.-K.2,3, Ye B.D.2,3

1University of Ulsan College of Medicine, Asan Medical Center, Internal Medicine, Seoul, South Korea 2University of Ulsan College of Medicine, Asan Medical Center, Gastroenterology, Seoul, South Korea 3University of Ulsan College of Medicine, Asan Medical Center, Inflammatory Bowel Disease Center, Seoul, South Korea

Background

Intestinal mucosal damage in Crohn's disease (CD) is believed to progress even in patients showing clinical remission. We aimed to investigate the difference in the long-term prognosis of CD patients in clinical remission depending on serum C-reactive protein (CRP) levels during clinical remission.

Methods

A total of 339 CD patients in clinical remission (defined by Crohn's disease activity index less than 150) for more than 6 months between January 2008 and December 2010 were enrolled in this study. Clinical outcomes represented by CD-related hospitalization, intestinal resection, perianal surgery, intestinal complications, and step-up of medical therapy were compared between normal CRP group and elevated CRP group during clinical remission.

Results

There were 150 patients with normal CRP through 6 months of clinical remission and 189 patients who showed elevated CRP at least once during 6 months of clinical remission. During follow-up (median, 7.9 years [interquartile range, 6.8–8.0]), the Kaplan-Meier analysis with the log-rank test showed the superiority of the normal CRP group compared with the elevated CRP group in terms of CD-related hospitalization-free survival (Figure 1A, p=0.007) and intestinal resection-free survival (Figure 1B, p=0.046).

Figure 1. Kaplan-Meier hospitalization-free survival curves (A) and intestinal resection-free survival curves (B).

In multivariate analysis, elevated CRP and Montreal penetrating behavior were associated with increased risk of CD-related hospitalization (adjusted hazard ratio [aHR] 1.787; 95% confidence interval [CI] 1.245–2.565, p=0.002, and aHR 2.175; 95% CI 1.489–3.177, p<0.001, respectively). In addition, elevated CRP, Montreal structuring behavior, Montreal penetrating behavior, and use of immunomodulators were associated with increased risk of intestinal resection (aHR 1.726; 95% CI 1.003–2.969, p=0.049, aHR 2.722; 95% CI 1.223–6.058, p=0.014, aHR 4.149; 95% CI 2.117–7.907, p<0.001, and aHR 2.147; 95% CI 1.076–4.284, p=0.030, respectively).

Conclusion

Even if patients with CD are in clinical remission, elevated CRP showed a significant association with poor prognosis represented by a higher risk of subsequent CD-related hospitalization and intestinal resection. More vigilant monitoring and therapeutic strategy are required for CD patients in remission, but with high CRP to improve long-term prognosis.