Silent Crohn's Disease: Asymptomatic Patients with Elevated C-reactive Protein Are at Risk for Subsequent Hospitalization

• Published in: Inflammatory bowel diseases 2015-10, Vol.21 (10), p.2254-2261
• Main Authors: Click, Benjamin, Vargas, Eric J, Anderson, Alyce M, Proksell, Siobhan, Koutroubakis, Ioannis E, Ramos Rivers, Claudia, Hashash, Jana G, Regueiro, Miguel, Watson, Andrew, Dunn, Michael A, Schwartz, Marc, Swoger, Jason, Baidoo, Leonard, Barrie, 3rd, Arthur, Binion, David G
• Format: Article
• Language: English
• Subjects: Adult; Asymptomatic Diseases; C-Reactive Protein - analysis; Crohn Disease - blood; Female; Hospitalization - statistics & numerical data; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Risk Factors; Severity of Illness Index; Surveys and Questionnaires
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1097/MIB.0000000000000516

Patient-reported Crohn's disease (CD) symptoms and endoscopic evaluation have historically guided routine care, but the risk of complications in asymptomatic patients with elevated C-reactive protein (CRP) is unknown. We conducted a prospective observational cohort study of patients with CD from a tertiary care center. Subjects with short inflammatory bowel disease questionnaire scores ≥ 50, Harvey-Bradshaw CD scores ≤ 4, and same-day CRP measurement were eligible for inclusion. The primary outcome was disease-related hospitalization up to 24 months after the qualifying clinic visit. We assessed the relationship between CRP elevation and subsequent hospitalization. There were 351 asymptomatic patients with CD (median age 40 yr; 50.4% female) who met inclusion criteria, and CRP was elevated in 19.7% of these individuals (n = 69). At 24 months, 16.8% (n = 59) of the study population had been hospitalized for CD-related complications. Significantly, more patients with an elevated CRP were hospitalized (33.3% versus 12.8%, P < 0.0001) compared with those with a normal CRP and were hospitalized at increased rate (P < 0.001) on Kaplan-Meier analysis. CRP elevation was significantly and independently associated with increased risk of hospitalization (adjusted hazard ratio 2.12; 95% confidence interval, 1.13-3.98; P = 0.02) in multivariable survival analysis. Asymptomatic patients with CD with elevated CRP are at a nearly 2-fold higher risk for hospitalization over the subsequent 2 years compared with asymptomatic patients with CD without CRP elevation.