Predictors of Complicated Disease Course in Adults and Children With Crohn's Disease: A Nationwide Study from the epi-IIRN

• Published in: Inflammatory bowel diseases 2024-12, Vol.30 (12), p.2370-2379
• Main Authors: Atia, Ohad, Lujan, Rona, Buchuk, Rachel, Greenfeld, Shira, Kariv, Revital, Loewenberg Weisband, Yiska, Ledderman, Natan, Matz, Eran, Ledder, Oren, Zittan, Eran, Yanai, Henit, Shwartz, Doron, Dotan, Iris, Nevo, Daniel, Turner, Dan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological Products - therapeutic use; Child; Crohn Disease - complications; Disease Progression; Female; Follow-Up Studies; Humans; Israel - epidemiology; Male; Middle Aged; Prognosis; Risk Factors; Severity of Illness Index; Young Adult
• ISSN: 1078-0998; 1536-4844; 1536-4844
• DOI: 10.1093/ibd/izae014

Since data on predictors of complicated Crohn's disease (CD) from unselected populations are scarce, we aimed to utilize a large nationwide cohort, the epi-IIRN, to explore predictors of disease course in children and adults with CD. Data of patients with CD were retrieved from Israel's 4 health maintenance organizations, whose records cover 98% of the population (2005-2020). Time-to-event modeled a complicated disease course, defined as CD-related surgery, steroid-dependency, or the need for >1 class of biologics. Hierarchical clustering categorized disease severity at diagnosis based on available laboratory results. A total of 16 659 patients (2999 [18%] pediatric-onset) with 121 695 person-years of follow-up were included; 3761 (23%) had a complicated course (750 [4.5%] switched to a second biologic class, 1547 [9.3%] steroid-dependency, 1463 [8.8%] CD-related surgery). Complicated disease was more common in pediatric- than adult-onset disease (26% vs 22%, odds ratio, 1.3; 95% confidence interval [CI], 1.2-1.4). In a Cox multivariate model, complicated disease was predicted by induction therapy with biologics (hazard ratio [HR], 2.1; 95% CI, 1.2-3.6) and severity of laboratory tests at diagnosis (HR, 1.7; 95% CI, 1.2-2.2), while high socioeconomic status was protective (HR, 0.94; 95% CI, 0.91-0.96). In children, laboratory tests predicted disease course (HR, 1.8; 95% CI, 1.2-2.5), as well as malnutrition (median BMI Z score -0.41; 95% CI, -1.42 to 0.43 in complicated disease vs -0.24; 95% CI, -1.23 to 0.63] in favorable disease; P