Introduction Objective of present study was to determine the perioperative behaviour of CRP in Crohn Disease (CD) in patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Our hypothesis is that perioperative CRP changes are disease-specific and therefore could detect subset of patient with more aggressive disease
Method 75 patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed perioperatively: preoperative, postoperative day 1 (POD1) and 5 (POD5). CD patients’ values were compared against same interval assessments of control groups undergoing right colectomy (Group B) and appendicectomy (Group C). Receiver operating characteristic (ROC) analysis identified a threshold value for any serum CRP associated with endoscopic recurrence in a test cohort (n 25) and subsequently validated in the whole series. Logistic regression for association between clinicopathological characteristics including perioperative serum CRP thresholds and endoscopic recurrence was performed.
Results In all 3 groups CRP significantly increased at POD1 vs baseline but the increase was significantly higher in CD patients than in controls (p < 0.001). Comparing to control groups CRP remained remarkably high in CD at POD5. Difference between groups was statistical significant (p < 0.001).
The ROC analysis performed in the preliminary test group (n 25) indicated a significant association between CRP serum levels at any different times and endoscopic recurrence with optimal cut-off levels for predicting endoscopic recurrence identified. Applying these thresholds in the whole study cohort (n 75) for validation, a serum CRP >39.8 mg/L at POD1 and >23.2 at POD5 have shown statistically significant association to endoscopic recurrence when using bivariate correlation. Binary logistic regression used to determine association between clinico-pathological characteristics already known as clinical predictor of disease severity and CRP concentration at any perioperative determination couldn’t demonstrate statistical significance for any of these variables in this limited series.
Conclusion This is the only study so far that investigates and confirms with preliminary data a disease-specific activation and up-regulation of CRP response in the postoperative period for CD patients undergoing surgery. We suggest that the degree of immunologic changes and related severity of disease might be explored immediately soon after surgery by determining peri-operative CRP modification. The postoperative CRP levels and kinetics seem to be related to the grade of mucosal inflammation and recurrence rate according to our 12 months endoscopic evaluation
Disclosure of interest None Declared.
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