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26.02.2019 | Original Article | Ausgabe 8/2019

Digestive Diseases and Sciences 8/2019

Cumulative Inflammation Could Be a Risk Factor for Intestinal Failure in Crohn’s Disease

Zeitschrift:
Digestive Diseases and Sciences > Ausgabe 8/2019
Autoren:
Yoshifumi Watanabe, Norikatsu Miyoshi, Shiki Fujino, Hidekazu Takahashi, Naotsugu Haraguchi, Taishi Hata, Chu Matsuda, Hirofumi Yamamoto, Yuichiro Doki, Masaki Mori, Tsunekazu Mizushima
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Abstract

Background

Intestinal failure is the most critical complication of Crohn’s disease. Intestinal failure requires home parenteral nutrition, which worsens the quality of life of the patients and sometimes causes life-threatening complications.

Aims

The purpose of this study was to investigate the incidence and risk factors for intestinal failure in Crohn’s disease.

Methods

We performed a retrospective analysis of Crohn’s disease patients (162 cases) at Osaka University Hospital between January 2000 and December 2017. Kaplan–Meier analysis was used to investigate the cumulative incidence of intestinal failure. To identify the risk factors of intestinal failure, patient characteristics were analyzed by multivariate analysis, including disease classification, surgical history, medical treatment other than surgery, and cumulative inflammation was calculated using the average C-reactive protein value and disease duration.

Results

The cumulative incidence of intestinal failure 5, 10, and 15 years after Crohn’s disease diagnosis was 2.6%, 3.4%, and 8.6%, respectively. Multivariate analysis identified the following as independent risk factors for intestinal failure in Crohn’s disease: residual small intestinal length < 200 cm (odds ratio 7.51, 95% confidence interval 2.14–29.96), non-use of anti-tumor necrosis factor-alpha therapy (3.34, 1.22–10.74), and cumulative inflammation (1.01, 1.001–1.038). We created a new predictive nomogram consisting of these risk factors.

Conclusions

Intestinal failure occasionally occurred during long-term treatment of Crohn’s disease. Cumulative inflammation for the first time, in addition to short residual small intestinal length and non-use of anti-tumor necrosis factor-alpha therapy, was shown to be potential risk factors for intestinal failure in Crohn’s disease.

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