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P193 Prediagnostic markers in late onset inflammatory bowel disease

P. Karling*1, D. Lundgren1, L. Widbom2, J. Hultdin2

1Department of Public Health and Clinical Medicine, Umeå University, Medicine, Umeå, Sweden, 2Department of Medical Biosciences, Umeå University, Clinical Chemistry, Umeå, Sweden

Background

We aimed to determine whether patients who later develop IBD show signs of inflammatory activity in blood measured with high-sensitivity CRP, calprotectin and albumin before clinical onset of inflammatory bowel disease (IBD).

Methods

We identified 96 subjects who participated in the heath survey ‘Northern Sweden Health and Disease Study’ and who later developed IBD (70 UC and 26 CD). High-sensitivity CRP, calprotectin and albumin was analysed in stored blood donated from cases and sex-age-matched controls 1 to 15 years before diagnosis.

Results

We found that subjects who later developed UC had lower albumin levels and subject who later developed CD had higher levels of CRP compared with the controls. Multi-variate conditional logistic regression with albumin, calprotectin and CRP showed a lower risk for developing IBD and UC with higher albumin levels (OR 0.789; CI 0.691–0.901 respective OR 0.773; CI 0.657–0.909). Higher CRP levels were associated with increased risk of developing CD (OR 1.314; CI 1.060–1.630). Adding BMI or smoking in the logistic regression model similar results was found. Serum calprotectin levels in the prediagnostic period in patients with IBD did not differ from controls.

Conclusion

This nested case–control study show that subjects who later develop IBD have signs of low-grade systemic inflammation years before the diseases become clinical. CRP and albumin was more sensitive to detect low-grade systemic inflammation than calprotectin.

Ulcerative colitisCaseControlp-valueN case/control
Median age, years50 (40–60)50 (40–60)0.85970/139
Median lag-time to diagnosis, years5.3 (2.6–7.3)nana70/na
Gender, women61%55%0.76670/139
Median BMI, kg/m225 (23.2–27.5)25.6 (23.1–27.8)0.81570/138
Smoking30%20%0.16265/128
Median albumin, g/l37.8 (35.7–39.1)38.5 (36.6–39.8)0.025*65/139
Median calprotectin, μg/l671 (496–947)693 (494–910)0.92565/137
Median CRP, mg/l1.08 (0.46–2.70)0.94 (0.49–2.52)0.68865/139

Basal characteristics for patients with ulcerative colitis and matched controls. Statistics: Mann–Whitney and χ2 test.

Crohn’s diseaseCaseControlp-valueN Case/control
Median age, years50 (40–57)50 (40–60)0.86126/52
Median lag-time to diagnosis, years4.7 (2.5–8.1)nana26/na
Gender, women46%50%0.93626/52
Median BMI, kg/m226.1 (23.1–30.4)25.3 (22.9–28.4)0.43326/52
Smoking35%17%0.17622/42
Median albumin, g/l37.0 (35.5–39.0)38.0 (36.1–40.3)0.07426/52
Median calprotectin, μg/l757 (520–1043)640 (464–925)0.36926/52
Median CRP, mg/l2.51 (0.34–8.71)0.83 (0.31–2.10)0.018*26/52

Basal characteristics for patients with Crohn’s disease and matched controls. Statistics: Mann–Whitney and χ2 test.