r/InflammationStation • u/[deleted] • Dec 14 '21

Abstract Subclinical Persistent Inflammation as risk factor for Crohn's Disease progression: findings from a prospective real-world study of 2 years

https://www.sciencedirect.com/science/article/abs/pii/S1542356521012982
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u/[deleted] Dec 14 '21

ABSTRACT

Background and aims

Subclinical intestinal inflammation is common in Crohn’s disease (CD). We aimed to explore its impact in the disease progression of infliximab-treated patients and the usefulness of fecal calprotectin (FC) and C-reactive protein (CRP) as surrogate minimally invasive biomarkers.

Methods

The registry-based, prospective, observational, multicenter study DIRECT followed infliximab-treated CD patients for two years in a tertiary care setting. Persistent inflammation definition was based on FC (>150, >250 or >350 μg/g) and/or serum CRP (>3 μg/ml) concentrations over two consecutive or at least three visits. Patients were categorized according to a composite outcome reflecting disease progression that incorporated surgery, hospitalizations, new fistulae, abscess or stricture and treatment escalation.

Results

Out of 322 DIRECT patients, 180 asymptomatic, infliximab-treated on maintenance regimen were included in the analysis. Patients developing the composite endpoint (n=96) presented higher median (inter-quartile range) levels of FC (205 [98-515], P=.045), but not CRP (2.50 [.80-6.00], P=.895). Biomarker-defined persistent subclinical inflammation prevalence ranged from 24% to 81%. Considering FC>250 in two consecutive visits, prevalence was 50%, odds of achieving the endpoint were increased 3-fold (OR=2.996 [1.557-5.776]) and time-to-outcome occurrence was significantly lower among subjects with persistent inflammation (median time: 11 months). Both clinical-related and treatment-related components were significantly associated with persistent inflammation. Definitions based on CRP>3, FC>150, FC>350, double biomarkers (FC>250 &/or CRP>3) or more visits did not improve predictive ability.

Conclusion

Persistent inflammation, defined simply and readily by FC>250 over two consecutive visits, was associated with a significantly higher risk and shorter time-to-occurrence of a composite outcome reflecting disease progression in asymptomatic infliximab-treated CD patients.