P139 Significant Changes In Routine Biochemical Markers Occur Up To 5 Years Prior To Inflammatory Bowel Disease Diagnosis: A Case-Control Study
Cohen, N.A.(1,2,3);Kliper, E.(4);Zamstein, N.(5);Ziv-Baran, T.(6);Ben Tov, A.(2,3);Kariv, R.(1,2,3);
(1)Tel Aviv Medical Center, Department of Gastroenterology and Liver Diseases, Tel Aviv, Israel;(2)Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel;(3)Maccabi Healthcare Services, Maccabi Institute for Research & Innovation, Tel Aviv, Israel;(4)MDClone Inc, MDClone, Beer Sheva, Israel;(5)MDClone Ltd, MDClone, Beer Sheva, Israel;(6)Sackler School of Medicine, Department of Public Health, Tel Aviv, Israel
Background – Early diagnosis of inflammatory bowel diseases (IBD) is associated with improved response to treatment and disease outcomes. Predicting patients at risk of developing symptomatic IBD would provide a window of opportunity to treat patients before irreversible bowel damage is caused. Our aim is to determine whether there is a pattern of change in use of health resources, medications and laboratory results in the years prior to diagnosis.
Methods – This is a retrospective study performed using electronic medical records (EMR) of Maccabi Health Services (MHS) which insures 25% of the Israeli population with a nationwide distribution. Data was extracted using MDClone (MDClone Ltd). IBD patients ≥ 16 years of age and minimum of 5 years follow up were identified by entry into the MHS IBD registry and included in the study. Demographic, clinical, medication and laboratory data was collected. Generalized estimating equation (GEE) model was applied to study trends and compare between years.
Results- A total of 5643 IBD patients were included. Of these, 3039 (53.8%) had Crohn’s disease (CD), 2322 (41.1%) had ulcerative colitis (UC) and 282 (5%) had indeterminate colitis (IC). The mean age of the total IBD population at inclusion to the registry was 39.3 ± 16.5 years. Overall, CD patients had significantly increased visits to general practitioners, emergency rooms and admissions compared to UC patients (33.2 vs 30, p<0.0001; 0.2 vs 0.17, p<0.0001 and 0.88 vs 0.71, p<0.0001, respectively). CD and IC patients had similar patterns of medical professional/institution visits. Laboratory parameters such as haemoglobin and mean corpuscular volume showed significant decrease and white blood count, platelets and c-reactive protein showed significant increase in mean values primarily in the 2 years prior to diagnosis with stable values prior to that (p<0.0001 for all parameters). In contrast, parameters such as creatinine, total protein, albumin and calcium showed earlier significant and progressive decreases in mean values starting 5 years prior to diagnosis (p<0.0001 for all parameters) (Figure 1). Use of medications such as nonsteroidal anti-inflammatory drugs, etanercept, steroids, proton pump inhibitors and antibiotics significantly increased in the 2 years prior to IBD registry entry (P<0.0001 for all).
Conclusion- There are clear changes from baseline in uptake of medical resources, medication usage and laboratory results in the 5 years prior to IBD diagnosis. Parameters such as creatinine and albumin give earlier signal than others. This data may allow the development of an algorithm stratifying patients into those who need more intensive follow-up or investigations to enable earlier disease diagnosis.