Clinical Predictors at Diagnosis for Disabling Crohn's Disease in Korea : Results from the CONNECT Study

Abstract

Background: Identification of Crohn's disease (CD) at high risk of disabling disease would be invaluable guidance for clinicians in making initial therapeutic strategy. The aim of this study was to identify at diagnosis factors predictive for subsequent 5-year disabling course and to validate previously proposed clinical predictors in Korea patients with CD. Methods: Among the 1,382 CD patients who comprise the retrospective cohort from 32 hospitals in Korea, we excluded patients underwent abdominal surgery within 1 month after diagnosis, received immunosuppressant or biologics therapy within 6 months of diagnosis, and those with shorter follow-up duration. A total of 843 patients with a follow-up of longer than 5 years were enrolled. The definition of disabling CD, which was modified from Saint-Antoine definition, included at least one of the following criteria: further hospitalization for flare-up or complications, need for immunosuppressant or biologics, intestinal resection or perianal surgery. Results: The rate of disabling CD during subsequent 5-years after diagnosis was 89.4%. An age below 40 years (Odd ratio [OR] : 5.3, 95% confidence interval [CI] : 3.232-8.751), the initial requirement for corticosteroids use (OR: 2.3, 95% CI: 1.116-4.797), and jejunal involvement (OR: 2.4, 95% CI: 1.113-5.169) were independently associated with disabling CD. Meanwhile, presence of perianal disease, which was significant predictor in previous study, was not related with disabling CD. Based on those three predictors, the positive predictive value of the risk factors for disabling disease was 0.62 (zero risk factor), 0.90 (one risk factor), 0.96 (two risk factors), and 1.00 (three risk factors).Conclusions: Predictors for subsequent 5-year disabling course are an age below 40 years, the initial requirement for corticosteroids, and jejunal involvement in Korean patients with CD. Further prospective validation of these parameters is warranted.