P0397 Nutritional status and the risk of proctectomy in patients with perianal fistulising Crohn’s disease
Authors: Martins B , Torminn Borges I S , Silva C , Lemos G , de Moraes Filho O , Ribeiro H , Silveira D , de Sousa J B 
Published: January 2025

Background

Perianal fistulas are the most common type of anal involvement in Crohn’s disease (CD), affecting approximately one-third of the patients.1 They are associated with a poor quality of life and can lead to significant disability.2 Despite combined medical and surgical treatments, many patients experience refractory disease, with up to 20% requiring proctectomy, which results in a permanent stoma.3 Consequently, investigating factors that may influence the outcomes of perianal disease is a critical area of research in CD. One such factor that remains to be explored is the impact of nutritional status on fistula healing and the overall prognosis of patients with perianal CD.4 This study aimed to evaluate how nutritional status influences the risk of undergoing proctectomy.

Methods

A retrospective cohort study was conducted with 64 patients with CD presenting chronic symptomatic anorectal fistulas. These patients underwent seton placement at two healthcare centres in Brasília, DF, Brazil, from January 2010 to December 2022. Data were extracted from the electronic patient records, including demographic and clinical characteristics. At the first hospital admission, nutritional risk screening was evaluated by applying the NRS-2002. The nutritional status was assessed retrospectively using the GLIM criteria. The prevalence of malnutrition and its association with the risk of proctectomy were analysed. Binary logistic regression with univariate analysis was used to screen independent risk factors for building a final multivariate model by including variables with clinical or statistical significance.

Results

Seventeen out of sixty-four patients were diagnosed with malnutrition (26.6%). The median follow-up was 53 months. The malnourished group had a higher prevalence of proctitis (100% vs 78.7%, p= 0.038) and lower mean albumin (34.7 vs 39.7 g/L, p= 0.002) and haemoglobin levels (10.9 vs 12.5 g/dL, p=0.003). Malnourished patients were younger at diagnosis (24.2 vs 30y, p=0.046) and presented lower BMI (19.7 vs 24.9 kg/m², p&lt;0.001), higher Harvey-Bradshaw Index levels (10 vs 5, p&lt;0.001) and rates of corticosteroid therapy (29.4% vs 4.3%, p= 0.012). The proctectomy rate was 47.1% in the malnourished group compared to 14.9% in non-malnourished patients (p=0.007). The binary logistic regression results indicated that malnutrition (OR=6.24; 95% CI= 1.27 - 30.57; p=0.024) was an independent risk factor for proctectomy.

Conclusion

Malnutrition, as assessed by GLIM criteria, was a significant risk factor for a proctectomy procedure in patients with CD presenting chronic symptomatic perianal fistulas. Future research should examine whether nutritional interventions can improve the prognosis of patients with perianal fistulising CD.

References

1.Eglinton TW, Barclay ML, Gearry RB, Frizelle FA. The Spectrum of Perianal Crohn’s Disease in a Population-Based Cohort. Diseases of the Colon & Rectum. 2012;55(7):773-777. doi:10.1097/DCR.0b013e31825228b0.

2.Atia O, Asayag N, Focht G, et al. Perianal Crohn’s Disease Is Associated With Poor Disease Outcome: A Nationwide Study From the epiIIRN Cohort. Clin Gastroenterol Hepatol. 2022;20(3):e484-e495. doi:10.1016/j.cgh.2021.04.007.

3.Singh B, McC Mortensen NJ, Jewell DP, George B. Perianal Crohn’s disease. British Journal of Surgery. 2004;91(7):801-814. doi:10.1002/bjs.4613.

4.Alves Martins BA, Filho ODM, Lopes ACB, et al. Nutritional status in perianal Crohn’s disease: are we underestimating the impact? Front Nutr. 2023;10:1271825. doi:10.3389/fnut.2023.1271825.