Skip to main content
main-content
Erschienen in: International Journal of Colorectal Disease 10/2019

24.08.2019 | Original Article

Predictive parameters for the clinical course of Crohn’s disease: development of a simple and reliable risk model

verfasst von: Andreas Stallmach, Bernd Bokemeyer, Ulf Helwig, Andreas Lügering, Niels Teich, Imma Fischer, Stefan Rath, Dorothee Lang, Carsten Schmidt, on behalf of the EPIC Study Group

Erschienen in: International Journal of Colorectal Disease | Ausgabe 10/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The aim of our study was to identify clinical parameters in recently diagnosed Crohn’s disease (CD) patients for prediction of their disease course.

Methods

EPIC (Early Predictive parameters of Immunosuppressive therapy in Crohn’s disease) is a prospective, observational study in 341 patients with a recent CD diagnosis (≤ 6 months), and naïve to immunosuppressants (IS) and anti-tumor necrosis factor α (TNF) agents. Patient characteristics were documented up to 2 years. In line with national and international guidelines, a complicated disease course was defined as need for immunosuppressants and/or anti-TNF agents, and CD-related hospitalization with or without immunosuppressants and/or anti-TNF agents.

Results

A total of 212 CD patients were analyzed of whom 57 (27%) had an uncomplicated disease within 24 months, while 155 (73%) had a complicated disease course: need for IS and/or anti-TNF agents (N = 115), CD-related hospitalization with or without IS/anti-TNF agents (N = 40). Identified risk predictors for a complicated disease were as follows: age at onset < 40 years (OR 2.3; 95% CI 1.2–4.5), anemia (OR 2.1; 95% CI 1.1–4.2), and treatment with systemic corticosteroids at first flare (OR 2.2; 95% CI 1.1–4.7). These three parameters were used to develop a risk model allowing prediction of the future disease course.

Conclusion

Our three-parameter model enables an assessment of each CD patient’s risk to develop a complicated disease course. Due to the easy accessibility of these parameters, this model can be utilized in daily clinical care to assist selecting the initial treatment for each individual patient.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, Gendre JP (2002) Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8(4):244–250 CrossRefPubMed Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, Gendre JP (2002) Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8(4):244–250 CrossRefPubMed
3.
Zurück zum Zitat Jess T, Riis L, Vind I, Winther KV, Borg S, Binder V, Langholz E, Thomsen OO, Munkholm P (2007) Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark. Inflamm Bowel Dis 13(4):481–489. https://​doi.​org/​10.​1002/​ibd.​20036 CrossRefPubMed Jess T, Riis L, Vind I, Winther KV, Borg S, Binder V, Langholz E, Thomsen OO, Munkholm P (2007) Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark. Inflamm Bowel Dis 13(4):481–489. https://​doi.​org/​10.​1002/​ibd.​20036 CrossRefPubMed
4.
Zurück zum Zitat D'Haens G, Baert F, van Assche G, Caenepeel P, Vergauwe P, Tuynman H, De Vos M, van Deventer S, Stitt L, Donner A, Vermeire S, Van de Mierop FJ, Coche JC, van der Woude J, Ochsenkuhn T, van Bodegraven AA, Van Hootegem PP, Lambrecht GL, Mana F, Rutgeerts P, Feagan BG, Hommes D (2008) Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet 371(9613):660–667. https://​doi.​org/​10.​1016/​s0140-6736(08)60304-9 CrossRefPubMed D'Haens G, Baert F, van Assche G, Caenepeel P, Vergauwe P, Tuynman H, De Vos M, van Deventer S, Stitt L, Donner A, Vermeire S, Van de Mierop FJ, Coche JC, van der Woude J, Ochsenkuhn T, van Bodegraven AA, Van Hootegem PP, Lambrecht GL, Mana F, Rutgeerts P, Feagan BG, Hommes D (2008) Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet 371(9613):660–667. https://​doi.​org/​10.​1016/​s0140-6736(08)60304-9 CrossRefPubMed
6.
Zurück zum Zitat Preiss JC, Bokemeyer B, Buhr HJ, Dignass A, Hauser W, Hartmann F, Herrlinger KR, Kaltz B, Kienle P, Kruis W, Kucharzik T, Langhorst J, Schreiber S, Siegmund B, Stallmach A, Stange EF, Stein J, Hoffmann JC (2014) Updated German clinical practice guideline on “Diagnosis and treatment of Crohn’s disease” 2014. Z Gastroenterol 52(12):1431–1484. https://​doi.​org/​10.​1055/​s-0034-1385199 CrossRefPubMed Preiss JC, Bokemeyer B, Buhr HJ, Dignass A, Hauser W, Hartmann F, Herrlinger KR, Kaltz B, Kienle P, Kruis W, Kucharzik T, Langhorst J, Schreiber S, Siegmund B, Stallmach A, Stange EF, Stein J, Hoffmann JC (2014) Updated German clinical practice guideline on “Diagnosis and treatment of Crohn’s disease” 2014. Z Gastroenterol 52(12):1431–1484. https://​doi.​org/​10.​1055/​s-0034-1385199 CrossRefPubMed
7.
Zurück zum Zitat Gomollon F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, Peyrin-Biroulet L, Cullen GJ, Daperno M, Kucharzik T, Rieder F, Almer S, Armuzzi A, Harbord M, Langhorst J, Sans M, Chowers Y, Fiorino G, Juillerat P, Mantzaris GJ, Rizzello F, Vavricka S, Gionchetti P, Ecco (2017) 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis 11(1):3–25. https://​doi.​org/​10.​1093/​ecco-jcc/​jjw168 CrossRefPubMed Gomollon F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, Peyrin-Biroulet L, Cullen GJ, Daperno M, Kucharzik T, Rieder F, Almer S, Armuzzi A, Harbord M, Langhorst J, Sans M, Chowers Y, Fiorino G, Juillerat P, Mantzaris GJ, Rizzello F, Vavricka S, Gionchetti P, Ecco (2017) 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis 11(1):3–25. https://​doi.​org/​10.​1093/​ecco-jcc/​jjw168 CrossRefPubMed
10.
Zurück zum Zitat Moon CM, Park DI, Kim ER, Kim YH, Lee CK, Lee SH, Kim JH, Huh KC, Jung SA, Yoon SM, Song HJ, Jang HJ, Kim YS, Lee KM, Shin JE (2014) Clinical features and predictors of clinical outcomes in Korean patients with Crohn’s disease: a Korean association for the study of intestinal diseases multicenter study. J Gastroenterol Hepatol 29(1):74–82. https://​doi.​org/​10.​1111/​jgh.​12369 CrossRefPubMed Moon CM, Park DI, Kim ER, Kim YH, Lee CK, Lee SH, Kim JH, Huh KC, Jung SA, Yoon SM, Song HJ, Jang HJ, Kim YS, Lee KM, Shin JE (2014) Clinical features and predictors of clinical outcomes in Korean patients with Crohn’s disease: a Korean association for the study of intestinal diseases multicenter study. J Gastroenterol Hepatol 29(1):74–82. https://​doi.​org/​10.​1111/​jgh.​12369 CrossRefPubMed
11.
Zurück zum Zitat Niewiadomski O, Studd C, Hair C, Wilson J, Ding NS, Heerasing N, Ting A, McNeill J, Knight R, Santamaria J, Prewett E, Dabkowski P, Dowling D, Alexander S, Allen B, Popp B, Connell W, Desmond P, Bell S (2015) Prospective population-based cohort of inflammatory bowel disease in the biologics era: disease course and predictors of severity. J Gastroenterol Hepatol 30(9):1346–1353. https://​doi.​org/​10.​1111/​jgh.​12967 CrossRefPubMed Niewiadomski O, Studd C, Hair C, Wilson J, Ding NS, Heerasing N, Ting A, McNeill J, Knight R, Santamaria J, Prewett E, Dabkowski P, Dowling D, Alexander S, Allen B, Popp B, Connell W, Desmond P, Bell S (2015) Prospective population-based cohort of inflammatory bowel disease in the biologics era: disease course and predictors of severity. J Gastroenterol Hepatol 30(9):1346–1353. https://​doi.​org/​10.​1111/​jgh.​12967 CrossRefPubMed
12.
Zurück zum Zitat Loly C, Belaiche J, Louis E (2008) Predictors of severe Crohn’s disease. Scand J Gastroenterol 43(8):948–954 CrossRefPubMed Loly C, Belaiche J, Louis E (2008) Predictors of severe Crohn’s disease. Scand J Gastroenterol 43(8):948–954 CrossRefPubMed
18.
Zurück zum Zitat Romberg-Camps MJ, Dagnelie PC, Kester AD, Hesselink-van de Kruijs MA, Cilissen M, Engels LG, Van Deursen C, Hameeteman WH, Wolters FL, Russel MG, Stockbrugger RW (2009) Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol 104(2):371–383. https://​doi.​org/​10.​1038/​ajg.​2008.​38 CrossRefPubMed Romberg-Camps MJ, Dagnelie PC, Kester AD, Hesselink-van de Kruijs MA, Cilissen M, Engels LG, Van Deursen C, Hameeteman WH, Wolters FL, Russel MG, Stockbrugger RW (2009) Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol 104(2):371–383. https://​doi.​org/​10.​1038/​ajg.​2008.​38 CrossRefPubMed
22.
Zurück zum Zitat Mow WS, Vasiliauskas EA, Lin YC, Fleshner PR, Papadakis KA, Taylor KD, Landers CJ, Abreu-Martin MT, Rotter JI, Yang H, Targan SR (2004) Association of antibody responses to microbial antigens and complications of small bowel Crohn’s disease. Gastroenterology 126(2):414–424 CrossRefPubMed Mow WS, Vasiliauskas EA, Lin YC, Fleshner PR, Papadakis KA, Taylor KD, Landers CJ, Abreu-Martin MT, Rotter JI, Yang H, Targan SR (2004) Association of antibody responses to microbial antigens and complications of small bowel Crohn’s disease. Gastroenterology 126(2):414–424 CrossRefPubMed
23.
Zurück zum Zitat Kiss LS, Papp M, Lovasz BD, Vegh Z, Golovics PA, Janka E, Varga E, Szathmari M, Lakatos PL (2012) High-sensitivity C-reactive protein for identification of disease phenotype, active disease, and clinical relapses in Crohn’s disease: a marker for patient classification? Inflamm Bowel Dis 18(9):1647–1654. https://​doi.​org/​10.​1002/​ibd.​21933 CrossRefPubMed Kiss LS, Papp M, Lovasz BD, Vegh Z, Golovics PA, Janka E, Varga E, Szathmari M, Lakatos PL (2012) High-sensitivity C-reactive protein for identification of disease phenotype, active disease, and clinical relapses in Crohn’s disease: a marker for patient classification? Inflamm Bowel Dis 18(9):1647–1654. https://​doi.​org/​10.​1002/​ibd.​21933 CrossRefPubMed
24.
Zurück zum Zitat Weersma RK, Stokkers PC, van Bodegraven AA, van Hogezand RA, Verspaget HW, de Jong DJ, van der Woude CJ, Oldenburg B, Linskens RK, Festen EA, van der Steege G, Hommes DW, Crusius JB, Wijmenga C, Nolte IM, Dijkstra G (2009) Molecular prediction of disease risk and severity in a large Dutch Crohn’s disease cohort. Gut 58(3):388–395. https://​doi.​org/​10.​1136/​gut.​2007.​144865 CrossRefPubMed Weersma RK, Stokkers PC, van Bodegraven AA, van Hogezand RA, Verspaget HW, de Jong DJ, van der Woude CJ, Oldenburg B, Linskens RK, Festen EA, van der Steege G, Hommes DW, Crusius JB, Wijmenga C, Nolte IM, Dijkstra G (2009) Molecular prediction of disease risk and severity in a large Dutch Crohn’s disease cohort. Gut 58(3):388–395. https://​doi.​org/​10.​1136/​gut.​2007.​144865 CrossRefPubMed
Metadaten
Titel
Predictive parameters for the clinical course of Crohn’s disease: development of a simple and reliable risk model
verfasst von
Andreas Stallmach
Bernd Bokemeyer
Ulf Helwig
Andreas Lügering
Niels Teich
Imma Fischer
Stefan Rath
Dorothee Lang
Carsten Schmidt
on behalf of the EPIC Study Group
Publikationsdatum
24.08.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 10/2019
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03369-0

Weitere Artikel der Ausgabe 10/2019

International Journal of Colorectal Disease 10/2019 Zur Ausgabe

Der einfache Weg sich fortzubilden: Befundungskurs Radiologie

Strukturiertes Interpretieren und Analysieren von radiologischen Befunden

Neu im Fachgebiet Chirurgie

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.