Dataset Information

Liver test abnormalities predict complicated disease behaviour in patients with newly diagnosed Crohn's disease.

ABSTRACT:

Backgrounds

In coeliac disease, the prevalence of liver test abnormalities (LTAs) is higher in patients with more severe mucosal inflammation. In Crohn's disease, prognosis is related to the severity of mucosal inflammation.

Aim

The aim of this study was to investigate whether the presence of LTA predicts the occurrence of complicated disease behaviour in newly diagnosed Crohn's disease.

Methods

A retrospective cohort study was performed in patients newly diagnosed with Crohn's disease between 2002 and 2011. The complicated disease was defined as the occurrence of stricturing and/or perforating disease. LTAs were defined as a value of any of alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), or alanine aminotransferase (ALT) over the upper limit of normal.

Results

Three hundred eighty-three patients were included, of whom 34.1% had LTA. LTAs were mostly mild (less than two times the upper limit of normal). During the 5-year follow-up, 33.1% of patients in the group with LTA developed complicated disease behaviour compared to 14.6% in patients without LTA (p < 0.001). The presence of LTA was identified as a risk factor for complicated disease behaviour (HR 2.6, 95% confidence interval (CI) 1.5-4.2, p < 0.0001).

Conclusions

In newly diagnosed Crohn's disease, the presence of LTA was an independent risk factor for the development of complicated disease behaviour.

SUBMITTER: Barendregt J

PROVIDER: S-EPMC5355514 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Publications

Liver test abnormalities predict complicated disease behaviour in patients with newly diagnosed Crohn's disease.

Barendregt Jessika J de Jong Myrthe M Haans Jeoffrey J JJ van Hoek Bart B Hardwick James J Veenendaal Roeland R van der Meulen Andrea A Srivastava Nidhi N Stuyt Rogier R Maljaars Jeroen J

International journal of colorectal disease 20161129 4

<h4>Backgrounds</h4>In coeliac disease, the prevalence of liver test abnormalities (LTAs) is higher in patients with more severe mucosal inflammation. In Crohn's disease, prognosis is related to the severity of mucosal inflammation.<h4>Aim</h4>The aim of this study was to investigate whether the presence of LTA predicts the occurrence of complicated disease behaviour in newly diagnosed Crohn's disease.<h4>Methods</h4>A retrospective cohort study was performed in patients newly diagnosed with Cro ...[more]

PMID: 27900523

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Project description:BACKGROUND:Stricturing and penetrating complications account for substantial morbidity and health-care costs in paediatric and adult onset Crohn's disease. Validated models to predict risk for complications are not available, and the effect of treatment on risk is unknown. METHODS:We did a prospective inception cohort study of paediatric patients with newly diagnosed Crohn's disease at 28 sites in the USA and Canada. Genotypes, antimicrobial serologies, ileal gene expression, and ileal, rectal, and faecal microbiota were assessed. A competing-risk model for disease complications was derived and validated in independent groups. Propensity-score matching tested the effect of anti-tumour necrosis factor ? (TNF?) therapy exposure within 90 days of diagnosis on complication risk. FINDINGS:Between Nov 1, 2008, and June 30, 2012, we enrolled 913 patients, 78 (9%) of whom experienced Crohn's disease complications. The validated competing-risk model included age, race, disease location, and antimicrobial serologies and provided a sensitivity of 66% (95% CI 51-82) and specificity of 63% (55-71), with a negative predictive value of 95% (94-97). Patients who received early anti-TNF? therapy were less likely to have penetrating complications (hazard ratio [HR] 0·30, 95% CI 0·10-0·89; p=0·0296) but not stricturing complication (1·13, 0·51-2·51; 0·76) than were those who did not receive early anti-TNF? therapy. Ruminococcus was implicated in stricturing complications and Veillonella in penetrating complications. Ileal genes controlling extracellular matrix production were upregulated at diagnosis, and this gene signature was associated with stricturing in the risk model (HR 1·70, 95% CI 1·12-2·57; p=0·0120). When this gene signature was included, the model's specificity improved to 71%. INTERPRETATION:Our findings support the usefulness of risk stratification of paediatric patients with Crohn's disease at diagnosis, and selection of anti-TNF? therapy. FUNDING:Crohn's and Colitis Foundation of America, Cincinnati Children's Hospital Research Foundation Digestive Health Center.

Dataset Information

Liver test abnormalities predict complicated disease behaviour in patients with newly diagnosed Crohn's disease.

Backgrounds

Aim

Methods

Results

Conclusions

Publications

Liver test abnormalities predict complicated disease behaviour in patients with newly diagnosed Crohn's disease.

Similar Datasets

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