Prediction Model Of Stricture Type Crohn's Disease Formation And Prognosis

Background&AimCrohn's disease is autoimmune and recurrent disease presents with skip and longitudinal ulcers in whole gastro-intestine.Abscess,stricture and fistula were the common complication in Crohn's disease.Stricture(or stenosis)is the most common complication among all.About half of the patients underwent stenosis after 10 years onset of diagnosis.Therefore,it is important to find out factors that could perfectly predict intestinal stenosis as well as which type of stenosis could receive successful non-surgical treatment.Herein,we would discuss the stricture type Crohn's disease through three parts of our research.Method:First part:Patients diagnosed Crohn's disease(diagnosed according to guidelines of the Chinese medical association)without stenosis from 2004 to 2017 were enrolled our study and assigned to one of two group:stenosis or non-stenosis.Cases in any of the following situations were excluded:acute intestinal infection,intestinal tuberculosis,lymphoma,severe hepatopathy/nephropathy,or colon carcinoma.The medical records within 18 months after the first diagnosis were available for all the selected cases.Those who underwent abscess and/or fistula were excluded as well.The following data were analyzed and compared between 2 groups:sex,age,laboratory test(albumin,C-reactive protein,platelet count,neutrophils,monocyte count)and SES-CD score.Second part:After searching the medical records of the patients admitted to the Nanfang Hospital(Southern Medical University,Guangdong Province,China),from January 2007 to April 2017,all cases with Crohn's disease-related intestinal obstruction(diagnosed according to guidelines of the Chinese medical association)were selected.Excluded criteria and data analysis was similar to first part.Third part:We have search article about Crohn's disease related stenosis through CNKI and Pubmed data base.This review article aim to conclude the therapy about Crohn's disease related stenosis.Result:First part:patients with stenosis,as opposed to non-stenosis had lower albumin(P<0.001)and higher C-reactive protein(P= 0.001),Platelet count(P = 0.004)and SES-CD score(P<0.001).Albumin(r =-0.513,P<0.001),CRP level(r ?0.403,P<0.001),platelet count(r = 0.464,P<0.001),neutrophils counts(r =0.318,P = 0.003)and monocyte count(r = 0.231,P = 0.03)were correlated to SES-CD score.Logistic regression revealed lower ALB(OR = 1.112,P = 0.037)and higher SES-CD score(OR=0.861,P=0.003)were more likely to experience stenosis within 18 months.SES-CD combine albumin showed better sensitivity,specificity and AUC(85.7%,64.1%,82.2%)than PLT/ALB ratio(66.7%,73.5%,73.1%)and CRP/ALB ratio(82.1%,49.0%,71.9%).SES-CD combine albumin revealed that patients who score over 0.51 receive early combination of AZA and Infliximab would more likely achieve better outcomes(P = 0.04,P = 0.06).Second part:Patients with successful,as opposed to unsuccessful,non-surgical treatment had higher serum ALB levels(P = 0.05)and lower serum CRP levels(P =0.008)and CRP/ALB ratios(P = 0.005).Univariate COX Hazard regression showed the possibility of successful non-surgical treatment was impacted by serum ALB(OR?1.070,P = 0.045),serum CRP(OR = 0.981,P = 0.035),serum CRP/ALB ratio(OR=0.512,P = 0.031)and the location of the obstruction.Multivariable COX Hazard regression indicated that patients with a higher CRP/ALB ratio(>7.5×10-4 vs.<7.5x 10-4)were less likely to experience successful non-surgical treatment(OR=0.282,P = 0.002).Patients with ileocecal obstruction were more likely to experience successful non-surgical treatment than those with colonic obstruction(OR = 0.446,P=0.045)or small intestinal obstruction(OR = 0.081,P = 0.001).Third part:According to the recent research,no medical therapy has revealed effectively cure stenosis.Endoscopic treatment include dilation,mucosal drug injection,stent implantation and strictureplasty.Last choice is surgery.Unfortunately none of these treatment could radically cure stenosis which imply that we still have long way to go.Conclusion1.PLT/ALB ratio>11.80 and CRP/ALB ratio>4.4*10-4 could predict intestinal stricture.2.SES-CD score combine albumin showed good predictive value in intestinal stricture.3.Patients whose score over 0.51 in the predictive formula consist of albumin and SES-CD score should receive early combination therapy.4.Within 1 years after diagnosis of Crohn's disease-related intestinal obstruction,patients with low CRP/ALB ratio(<7.5×10-4)are more likely to have a successful response to non-surgical treatment than patients with a higher CRP/ALB ratio(>7.5x10-4).5.Obstruction in ileocecal valve were more likely to receive successful non-surgical treatment than Large bowel or small intestine.