Elevated C-reactive protein level during clinical remission can predict poor outcomes in patients with Crohn’s disease

Abstract

Intestinal inflammation and mucosal damage in Crohn’s disease (CD) are believed to progress even during clinical remission. We investigated the long-term prognosis of CD patients in clinical remission according to serum C-reactive protein (CRP) levels. This study included 339 CD patients in clinical remission (Crohn’s disease activity index < 150) for more than 6 months between January 2008 and December 2010. Clinical outcomes were compared between patients with normal and elevated CRP levels during clinical remission. During clinical remission, 150 patients had normal CRP consistently and 189 had elevated CRP at least once. During follow-up (median, 7.9 years [interquartile range, 6.8–8.0]), the Kaplan–Meier analysis with the log-rank test showed that normal CRP group had a longer CD-related hospitalization-free survival (P = 0.007) and a longer CD-related intestinal resection-free survival (P = 0.046) than elevated CRP group. In multivariate analysis, elevated CRP was significantly and independently associated with an increased risk of subsequent CD-related hospitalization (adjusted hazard ratio [aHR] 1.787, 95% confidence interval [CI]: 1.245–2.565, P = 0.002) and of subsequent CD-related intestinal resection (aHR 1.726, 95% CI: 1.003–2.969, P = 0.049). The most common reason for CD-related hospitalization was penetrating complications (35.6%). Even when CD patients are in clinical remission, elevated CRP is significantly associated with subsequent CD-related hospitalization and CD-related intestinal resection during follow-up. CD patients in clinical remission but elevated CRP should receive more careful attention and timely interventions to improve long-term outcomes.

Gastrointestinal hypoalgesia in inflammatory bowel disease

“…Additionally, when comparing active and inactive IBD cohorts reporting little to no pain, we found that several inflammatory markers (including WBC, platelet count, ESR and CRP) may be elevated in hypoalgesic IBD, supporting the findings of previous studies [8,25]. However, a quarter or more of these patients will demonstrate normal inflammatory markers, demonstrating the potential limitation of this type of testing.…”

“…Several endoscopic, radiologic and laboratory tests have been proposed as screening options for silent IBD [11,[21][22][23][24][25], but their clinical practicality and cost-effectiveness are still uncertain, particularly when the scale of this issue remains incompletely understood. To this point, no studies have specifically evaluated for reduced abdominal pain perception in IBD patients while simultaneously evaluating disease activity using the most reliable assessment methods (e.g., direct endoscopic visualization).…”

Characteristics of Upper Gastrointestinal Tract Involvement in Korean Pediatric Crohn's Disease: A Multicenter Study

“…According to previous research, increased CRP in adult patients with CD increases the risk of CD-related hospitalization and CD-related intestinal resection. CRP levels >1 mg/dL have been found to be correlated with granulomatous CD in pediatric patients in the United States [ 26 27 28 29 ]. In the present study, we found that ESR and CRP significantly increased in the presence of upper GI symptoms.…”

Proteome profiling of gestational diabetes mellitus at 16‐18 weeks revealed by LC‐MS/MS

“…C‐reactive protein (CRP) is routinely used in the diagnosis for monitoring infections especially in the obstetric field 36,37 . CRP is also an important biomarker for predicting long‐term outcome in inflammatory disease 38 . Carbone et al 29 showed that maternal serum levels of CRP during the second trimester of pregnancy represent a useful predictor of maternal adverse outcome occurrence.…”