P0454 Predictive value of postoperative CRP levels on endoscopic recurrence in Crohn’s disease patients undergoing Ileocolic resection
Authors: Haanappel A , Van Tieghem C , Ali M , Wolthuis A , Vlug M , Bemelman W , D’Hoore A , Buskens C , Bislenghi G 
Published: January 2025

Background

Patients with Crohn’s disease (CD) undergoing ileocolic resection (ICR) develop higher postoperative C-reactive protein (CRP) levels compared to patients undergoing surgery for colorectal cancer (CRC), suggesting an increased postoperative inflammatory response. (1,2) This study aims to identify whether postoperative CRP levels are associated with endoscopic recurrence in CD patients undergoing ICR.

Methods

CD patients (≥18 years) who underwent ICR between 2007-2022 at two referral centres (Amsterdam UMC and University Hospital Leuven) were included. CRP levels were measured postoperatively and endoscopy was performed within 12 months after ICR. Endoscopic recurrence (ER) was defined as modified Rutgeerts score ≥i2b. The primary outcome was the association between postoperative CRP levels and endoscopic recurrence. Secondary outcome was the added prognostic value of postoperative CRP levels for ER, compared to traditional risk factors (i.e., smoking, disease behaviour, prophylactic treatment, and perianal location. (3) Multivariable logistic regression and linear mixed models were used.

Results

A total of 610 patients were included (median age at surgery 31.5 years [IQR 24.0-43.3], 323 [53%] female). The majority of patients presented with stricturing (266 [44%]) or penetrating disease behaviour (229 [38%]) at time of surgery, and 159 patients (26%) were active smokers. Prophylactic therapy (&lt; 8 weeks postoperative) was initiated in 97/606 (16%) of the patients. In total, 548 patients (90%) had an available endoscopy within one year postoperatively. ER was observed in 243/543 (38%) patients. Patients with ER had numerically higher CRP levels on postoperative day (POD) 2 to 5 compared to patients who did not develop ER, but this difference was most significant on POD 4 (mean, 97 vs 86; adjusted difference, 14% [1 to 26%]; P=0.041; Figure 1). After adjusting for traditional risk factors, CRP level on POD 4 remained an independent predictor of ER (P=0.040; Figure 2).

Conclusion

In CD patients undergoing ICR, high postoperative CRP levels on postoperative day 4 is independently associated with an increased risk of endoscopic recurrence within 12 months. In addition, patients with ER had numerically higher CRP levels on Postoperative day 2 to 5.

References

1.de Buck van Overstraeten A, Van Hoef S, Vermeire S, Ferrante M, Fieuws S, Wolthuis A, et al. Postoperative Inflammatory Response in Crohn’s Patients: A Comparative Study. J Crohns Colitis. 2015;9(12):1127-31.

2.Iaculli E, Agostini M, Biancone L, Fiorani C, Di Vizia A, Montagnese F, et al. C-reactive protein levels in the perioperative period as a predictive marker of endoscopic recurrence after ileo-colonic resection for Crohn’s disease. Cell Death Discov. 2016;2:16032.

3.Gionchetti P, Dignass A, Danese S, Magro Dias FJ, Rogler G, Lakatos PL, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 2: Surgical Management and Special Situations. J Crohns Colitis. 2017;11(2):135-49.

Figure 1. Postoperative CRP levels in patients with and without endoscopic recurrence, estimated using linear mixed models.

Figure 2. Multivariable model for endoscopic recurrence