Risk factors and prognostic value of acute severe lower gastrointestinal bleeding in Crohn's disease
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Jiyoung Yoon1, Dae Sung Kim1, Ye-Jee Kim2
1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea.
Insights
Early thiopurine use and female sex may reduce the risk of acute severe lower gastrointestinal bleeding (LGIB) in Crohn's disease (CD) patients. However, a history of LGIB does not appear to significantly impact long-term CD outcomes.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Inflammatory Bowel Disease Research
Background:
- Acute severe lower gastrointestinal bleeding (LGIB) presents a significant clinical challenge in Crohn's disease (CD) management.
- Identifying predictors and long-term impacts of LGIB is crucial for optimizing patient care.
Purpose of the Study:
- To determine factors predicting acute severe LGIB in CD patients.
- To assess the influence of acute severe LGIB on the subsequent clinical trajectory of CD.
Main Methods:
- Retrospective cohort study involving CD patients with and without acute severe LGIB.
- Utilized multivariable Cox regression and matched analysis to identify risk factors and prognostic value.
Main Results:
- Early thiopurine administration (HR: 0.23) and female sex (HR: 0.51) were associated with reduced LGIB risk.
- No significant difference in cumulative risks for disease progression or intestinal resection between bleeding and non-bleeding groups.
- Higher hospitalization rates in the bleeding group, but this difference disappeared when excluding bleeding-related admissions.
Conclusions:
- Early thiopurine therapy may serve as a protective factor against acute severe LGIB in CD.
- Acute severe LGIB history may not be a significant predictor of long-term clinical outcomes in Crohn's disease.
Background:
Acute severe lower gastrointestinal bleeding (LGIB) is an uncommon but challenging complication of Crohn's disease (CD).
Aim:
To identify the predictors of acute severe LGIB and to evaluate the impact of acute severe LGIB on the subsequent clinical course in CD patients.
Methods:
A retrospective inception cohort study was conducted in 75 CD patients with acute severe LGIB and 1359 CD patients without acute severe LGIB who were diagnosed between February 1991 and November 2019 at Asan Medical Center, a tertiary university hospital in Korea. Multivariable analysis with Cox proportional hazard regression was performed to identify the risk factors for acute severe LGIB. A matched analysis using 72 patients with bleeding and 267 matched patients without within the cohort was also conducted to investigate whether acute severe LGIB is a predictor of clinical outcomes of CD.
Results:
Multivariable Cox regression analysis revealed that early use of thiopurines [hazard ratio (HR): 0.23, 95% confidence interval (CI): 0.12-0.48; P < 0.001] and female sex (HR: 0.51, 95%CI: 0.27-0.94; P = 0.031) were significantly associated with a lower risk of acute severe LGIB. The cumulative risks of behavioral progression and intestinal resection were not significantly different between the two matched groups (P = 0.139 and P = 0.769, respectively). The hospitalization rate was higher in the bleeding group than in the matched non-bleeding group (22.1/100 vs 13.2/100 patient-years; P = 0.012). However, if hospitalizations due to bleeding episodes were excluded from the analysis, the hospitalization rate was not significantly different between the bleeding group and the matched non-bleeding group (14.5/100 vs 13.2/100 patient-years; P = 0.631).
Conclusion:
Early use of thiopurines may reduce the risk of acute severe LGIB. History of acute severe LGIB may not have a significant prognostic value in patients with CD.
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