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P304 Predicting severity in Crohn's disease

C. Gouveia*1, C. Gomes1, L. Glória1, J. Torres1, M. Cravo2

1Hospital Beatriz Ângelo, Gastroenterology, Lisbon, Portugal, 2Hospital Beatriz Ângelo, Gastroenterology, Lisboa, Portugal

Background

Stratification of patients with Crohn's disease (CD) according to the risk of developing complications is essential to delineate therapeutic approach. A recent score (Siegel et al., Gut 2017) aims to assess disease severity, considering clinical and endoscopic activity, and complications during disease course, ranging from 0 to 100 values. Purpose: Evaluate the predictive capacity of this score at diagnosis (dx) for disease complications during the follow-up (surgery and hospitalisation).

Methods

Retrospective study, including incident patients with CD at our hospital between January 2012 and July 2017. The score was calculated at dx and at the end of follow-up, and information about disease course was collected.

Results

In total, 64 patients (32 women), with mean age at dx 33.4 ± 15.4 years. At dx 29 patients (45%) had L1 disease, 12 patients L2, 22 patients L3, and 1 patient L4. Forty-three patients (67%) had B1 phenotype, 7 patients B2, and 14 patients B3. At follow-up, 28 patients (44%) required surgery, 33 (52%) required hospitalisation, and 2 had phenotype progression. Median score at dx was 16 (4–50) and at follow-up was 9 (0–39). At dx score was higher in younger patients (22 A1 vs. 14 A3, p = 0.05), patients with penetrating phenotype (25 B3 vs. 11 B2, p = 0.005) and there was a tendency to a higher score in patients with upper GI disease (26 vs. 18, p = 0.07) and in those requiring surgery (21 vs. 18, p = 0.1). There was a positive correlation between score at dx and number of surgeries (r = 0.29, p = 0.002) and hospitalisations (r = 0.37, p = 0.018). There was a tendency for patients with a higher score at dx to have a shorter mean time to surgery (p log-rank=0.07). At follow-up, there was a score decrease in 46 patients (72%), with 11 having a score of 0, an increase in 16 patients, and the score remained the same in 2 patients. Patients in whom the score decreased below median (<16) were more frequently patients without hospitalisations (p = 0.03) or surgeries (p = 0.008) at follow-up. There was no difference in score at follow-up regarding different therapies.

Conclusion

The aforementioned severity score seems to be a promising instrument for stratification and prognosis of patients with CD, and its usefulness should be validated in prospective studies.