P0452 Complicated and Extra-Complicated Crohn’s Disease Course: a Prospective Inception Real-World Cohort
T Sharar Fischler, I Goren, J E Ollech, H Banai-Eran, I Avni-Biron, Y Snir, Y Broitman, A Freidenberg, M H Pauker, I Dotan, H YanaiAbstract
Background
Crohn’s disease (CD) is a heterogeneous condition with a potentially complicated course. We aimed to evaluate the rates of a complicated disease course within a real-world prospective inception cohort of patients with newly diagnosed CD (ndCD).
Methods
A prospective, observational, longitudinal cohort study involving consecutive adults with ndCD was conducted at a tertiary referral center. Patients were managed at the discretion of their treating physician. Key outcomes were defined as ‘complicated disease course’ (any CD-related hospitalization, any CD-related surgery, steroid dependency, or ≥2 biologics) and ‘extra-complicated disease course’ (recurrent or >5-days hospitalization, multiple perianal procedures, CD-related intestinal resection, or ≥3 biologics) over time. The Chi-square Automatic Interaction Detector (CHAID) technique was used to identify cutoffs of clinical indices and blood count values at diagnosis associated with a complicated disease course at one year post-diagnosis. Kaplan-Meier survival analysis was used to assess complication rates over time, and multivariable Cox regression analysis was used to identify risk factors.
Results
A total of 192 patients with ndCD with a median age of 26 years (IQR: 21-36) were included, of whom 45.8% were female. Phenotypes included 18.8% with stricturing (B2), 9.9% with penetrating (B3), and 19.3% with perianal (P) disease. The median follow-up period was 3.9 years (IQR: 1.5-5). The cumulative rates of complicated and extra-complicated disease courses were 24.2% and 12.9% at one year, 35.9% and 18.9% at three years, and 51.3% and 26.6% at five years post-diagnosis, respectively. Patients with progressive phenotypes (B2, B3, or P) at diagnosis had a significantly elevated risk for both complicated (HR 3.362, 95% CI: 1.992-5.673) and extra-complicated disease course (HR 6.724, 95% CI: 3.36-14.418). Baseline laboratory values contributing to risk stratification included a platelet count above 370x103/uL (HR 2.64, 95% CI: 1.583-4.401 for complicated course; HR 4.105, 95% CI: 2.043-8.247 for extra-complicated course) and lymphocyte count above 1.2x103/uL (HR 1.800, 95% CI: 1.034-3.133 for extra-complicated course).
Conclusion
Nearly half of patients with ndCD experience a complicated disease course within five years, with progressive phenotypes at diagnosis significantly increasing the risk. Elevated platelet and lymphocyte count at diagnosis may further identify individuals at a higher risk for adverse outcomes (‘extra-complicated course’).