Evaluation of Acute Terminal Ileitis in Hospitalized Patients: Development of a Predictive Model to Distinguish Crohn's Disease from Other Etiologies

• Published in: Journal of clinical medicine 2024-08, Vol.13 (17), p.5030
• Main Authors: Bermont, Anton, Abu-Freha, Naim, Aminov, Refael, Vosko, Sergei, Shirin, Haim, Cohen, Daniel L
• Format: Article
• Language: English
• Subjects: Abdomen; Appendicitis; Chronic illnesses; Crohn's disease; Diarrhea; Emergency medical care; Etiology; Hospitalization; Inflammatory bowel disease; Intervention; Laboratories; Lymphocytes; Medical history; Medical imaging; Neutrophils; Small intestine; Variables
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13175030

: Terminal ileitis (TI) is often identified on CT scans in emergency settings. Diagnosing Crohn's disease (CD) as a cause of TI is crucial due to its significant long-term implications. This study aimed to differentiate CD from other causes of acute TI and develop a predictive model for CD diagnosis. : A retrospective case-control study was conducted at Shamir Medical Center including adults diagnosed with acute TI from January 2012 to December 2020. Patients with a history of inflammatory bowel disease or prior intestinal surgery were excluded. Patients were categorized into CD and non-CD groups based on their subsequent clinical course. A logistic regression model was developed and subsequently validated with additional patients hospitalized between 2021 and 2023. : Among 135 patients, 37 (27.4%) were diagnosed with CD. CD patients were younger (median age 27 vs. 39 years, = 0.003), predominantly male (83.8% vs. 51%, = 0.001), and had higher rates of chronic abdominal pain, diarrhea, anemia, and weight loss prior to hospitalization. Significant laboratory differences included higher platelet counts ( = 0.006) and lower mean corpuscular volume (MCV) ( = 0.001) in CD patients. Radiologic signs of complicated disease were more common in CD (35.1% vs. 4.1%, < 0.001). The predictive model incorporating gender, abdominal pain history, and MCV showed an area under the curve (AUC) of 0.87, with a sensitivity of 100% and specificity of 63.6% in the validation group of 18 patients. : This study identified key predictors of CD in patients presenting with acute TI and developed a predictive model with a substantial diagnostic capability. Use of this model for early identification and treatment of CD may potentially improve patient outcomes. Further prospective validation of this model is warranted.