Predictors of severe Crohn's disease

A model based on clinical characteristics at diagnosis and predicting the early development of disabling Crohn's disease (CD) has recently been proposed in order to target patients for early intervention. The objectives of this study were to confirm the predictive factors established in a previous study and to establish the predictive factors for the development of severe disease characterized by the development of clinically significant non-reversible damage.

Our retrospective study comprised a total of 361 patients with CD from our clinical database with a follow-up of longer than 5 years. Clinical, demographic and biological factors associated with the development of disabling disease (according to predefined criteria) within 5 years after the diagnosis of CD and with the time to development of severe disease (according to predefined criteria) were successively studied by univariate and multivariate analyses.

The rate of disabling CD within 5 years after diagnosis was 57.9%. Perianal lesions, the need for steroids to treat the first flare and ileo-colonic location, but not age below 40 years were confirmed as predictive markers. The rate of severe disease was 37.4%. Stricturing behaviour (HR: 2.11 (95% CI: 1.39-3.20)) and loss of weight (> 5 kg) (HR: 1.67 (95% CI: 1.14-2.45)) at diagnosis were independently associated with the time to development of severe disease. The predictive performances of the models generated were low.

Disabling and severe CD developed in roughly one-third and two-thirds of our patients, respectively. Some clinical predictive markers could be found or even confirmed but their performances were low.