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C-reactive protein levels in the perioperative period as a predictive marker of endoscopic recurrence after ileo-colonic resection for Crohn ’ s disease

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to determine the perioperative behavior of C-reactive protein (CRP) in Crohn’s disease (CD) patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Study hypothesis was that perioperative CRP changes are disease specific and could detect subset of patients with more aggressive pathopysiology. Seventy-five patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed: preoperative, postoperative day 1 (POD1) and day 5 (POD5). CD patients’ values were compared against same interval assessments of control groups undergoing right colectomy and appendicectomy. At POD1, the serum concentration increase was significantly higher in CD patients than in controls. Comparing with control groups, CRP levels remained remarkably high and showed a lower reduction in CD at POD5. Difference between groups was statistically significant. Optimal cutoff levels have been identified: serum CRP concentrations of >39.8 mg/l at POD1 and of >23.2 mg/l at POD5 have shown a significant association to endoscopic recurrence when using bivariate correlation. In this preliminary series, binary logistic regression could not demonstrate statistical relationship between endoscopic recurrence and any of the variables evaluated as prognostic factor. This is the only study so far that investigates and confirms a disease-specific upregulation of CRP response in the perioperative period for CD patients undergoing surgery. 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.

No MeSH data available.


Related in: MedlinePlus

Comparison of serum CRP perioperative levels (mean±S.E.M) in patients with and without endoscopic recurrence at 12 months. The study population has been divided into two subgroups according to the presence of endoscopic recurrence (Rutgeerts' score ≥2) at 12 months. Boxplots show differences between the two subgroups in serum CRP concentration for each determination timepoint (a–c) and its kinetics (d and e). The dotted line shows the calculated CRP cutoff used as a prognostic factor for endoscopic recurrence. Calculated CRP cutoffs seem to be able to discriminate between the two groups: patients developing recurrence show higher CRP levels and constantly above the given diagnostic threshold in each determination except for the preoperative one.
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fig4: Comparison of serum CRP perioperative levels (mean±S.E.M) in patients with and without endoscopic recurrence at 12 months. The study population has been divided into two subgroups according to the presence of endoscopic recurrence (Rutgeerts' score ≥2) at 12 months. Boxplots show differences between the two subgroups in serum CRP concentration for each determination timepoint (a–c) and its kinetics (d and e). The dotted line shows the calculated CRP cutoff used as a prognostic factor for endoscopic recurrence. Calculated CRP cutoffs seem to be able to discriminate between the two groups: patients developing recurrence show higher CRP levels and constantly above the given diagnostic threshold in each determination except for the preoperative one.

Mentions: These threshold values have therefore been applied for validation in the whole study cohort using bivariate correlation. All but preoperative values identified have been proven statistically significant for the study population of CD patients as demonstrated in Table 3. Figures 4a–e show the different distribution of CRP levels at the given perioperative measurement times in patients who subsequently developed endoscopic recurrence at 1 year and those who did not.


C-reactive protein levels in the perioperative period as a predictive marker of endoscopic recurrence after ileo-colonic resection for Crohn ’ s disease
Comparison of serum CRP perioperative levels (mean±S.E.M) in patients with and without endoscopic recurrence at 12 months. The study population has been divided into two subgroups according to the presence of endoscopic recurrence (Rutgeerts' score ≥2) at 12 months. Boxplots show differences between the two subgroups in serum CRP concentration for each determination timepoint (a–c) and its kinetics (d and e). The dotted line shows the calculated CRP cutoff used as a prognostic factor for endoscopic recurrence. Calculated CRP cutoffs seem to be able to discriminate between the two groups: patients developing recurrence show higher CRP levels and constantly above the given diagnostic threshold in each determination except for the preoperative one.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979416&req=5

fig4: Comparison of serum CRP perioperative levels (mean±S.E.M) in patients with and without endoscopic recurrence at 12 months. The study population has been divided into two subgroups according to the presence of endoscopic recurrence (Rutgeerts' score ≥2) at 12 months. Boxplots show differences between the two subgroups in serum CRP concentration for each determination timepoint (a–c) and its kinetics (d and e). The dotted line shows the calculated CRP cutoff used as a prognostic factor for endoscopic recurrence. Calculated CRP cutoffs seem to be able to discriminate between the two groups: patients developing recurrence show higher CRP levels and constantly above the given diagnostic threshold in each determination except for the preoperative one.
Mentions: These threshold values have therefore been applied for validation in the whole study cohort using bivariate correlation. All but preoperative values identified have been proven statistically significant for the study population of CD patients as demonstrated in Table 3. Figures 4a–e show the different distribution of CRP levels at the given perioperative measurement times in patients who subsequently developed endoscopic recurrence at 1 year and those who did not.

View Article: PubMed Central - PubMed

ABSTRACT

The aim of this study was to determine the perioperative behavior of C-reactive protein (CRP) in Crohn’s disease (CD) patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Study hypothesis was that perioperative CRP changes are disease specific and could detect subset of patients with more aggressive pathopysiology. Seventy-five patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed: preoperative, postoperative day 1 (POD1) and day 5 (POD5). CD patients’ values were compared against same interval assessments of control groups undergoing right colectomy and appendicectomy. At POD1, the serum concentration increase was significantly higher in CD patients than in controls. Comparing with control groups, CRP levels remained remarkably high and showed a lower reduction in CD at POD5. Difference between groups was statistically significant. Optimal cutoff levels have been identified: serum CRP concentrations of >39.8 mg/l at POD1 and of >23.2 mg/l at POD5 have shown a significant association to endoscopic recurrence when using bivariate correlation. In this preliminary series, binary logistic regression could not demonstrate statistical relationship between endoscopic recurrence and any of the variables evaluated as prognostic factor. This is the only study so far that investigates and confirms a disease-specific upregulation of CRP response in the perioperative period for CD patients undergoing surgery. 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.

No MeSH data available.


Related in: MedlinePlus