High-sensitivity C-reactive protein for identification of disease phenotype, active disease, and clinical relapses in Crohn's disease: A marker for patient classification?

Lajos Sandor Kiss, M. Papp, Barbara Dorottya Lovasz, Zsuzsanna Vegh, Petra Anna Golovics, Eszter Janka, Eva Varga, M. Szathmári, P. Lakatos

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: C-reactive protein (CRP) is a traditional nonspecific marker of inflammation, with Crohn's disease (CD) being associated with a strong CRP response. Thus far, no clear cutoff values have been determined. The authors' aim was to investigate whether high-sensitivity (hs)-CRP is useful for the identification disease phenotype, active disease, and relapse during follow-up, using a classification based on the hs-CRP value at diagnosis. Methods: In all, 260 well-characterized, unrelated, consecutive CD patients (male/female: 120/140; duration: 7.0 ± 6.1 years), with a complete clinical follow-up, were included. Hs-CRP, clinical activity according to the Harvey-Bradshaw Index, and clinical data (disease phenotype according to the Montreal Classification, extraintestinal manifestations, smoking habits, medical therapy, and surgical events) were prospectively collected between January 1, 2008 and June 1, 2010. Medical records prior to the prospective follow-up period were analyzed retrospectively. Results: In all, 32.3% of CD patients had normal hs-CRP at diagnosis. Elevated hs-CRP at diagnosis was associated with disease location (P = 0.002), noninflammatory disease behavior (P = 0.058), and a subsequent need for later azathioprine/biological therapy (P <0.001 and P = 0.024), respectively. The accuracy of hs-CRP for identifying patients with active disease during prospective follow-up was good (area under the curve [AUC]: 0.82, cutoff: 10.7 mg/L). AUC was better in patients with an elevated hs-CRP at diagnosis (AUC: 0.92, cutoff: 10.3 mg/L). In Kaplan-Meier and Cox-regression analyses, hs-CRP was an independent predictor of 3- (P = 0.007) or 12-month (P = 0.001) clinical relapses for patients in remission who had elevated hs-CRP at diagnosis. In addition, perianal involvement (P = 0.01) was associated with the 12-month relapse frequency. Conclusions: Our data suggest that hs-CRP positivity at diagnosis is associated with disease location and behavior, and in patients who are hs-CRP positive at diagnosis, is an accurate marker of disease activity and a predictor of short- and medium-term clinical flare-ups during follow-up.

Original languageEnglish
Pages (from-to)1647-1654
Number of pages8
JournalInflammatory Bowel Diseases
Volume18
Issue number9
DOIs
Publication statusPublished - Sep 2012

Fingerprint

Crohn Disease
C-Reactive Protein
Phenotype
Recurrence
Area Under Curve
Biological Therapy
Azathioprine
Habits
Medical Records
Smoking
Regression Analysis
Inflammation

Keywords

  • CD
  • clinical activity
  • flare-up
  • hs-CRP
  • prediction
  • risk

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

Cite this

High-sensitivity C-reactive protein for identification of disease phenotype, active disease, and clinical relapses in Crohn's disease : A marker for patient classification? / Sandor Kiss, Lajos; Papp, M.; Dorottya Lovasz, Barbara; Vegh, Zsuzsanna; Anna Golovics, Petra; Janka, Eszter; Varga, Eva; Szathmári, M.; Lakatos, P.

In: Inflammatory Bowel Diseases, Vol. 18, No. 9, 09.2012, p. 1647-1654.

Research output: Contribution to journalArticle

Sandor Kiss, Lajos ; Papp, M. ; Dorottya Lovasz, Barbara ; Vegh, Zsuzsanna ; Anna Golovics, Petra ; Janka, Eszter ; Varga, Eva ; Szathmári, M. ; Lakatos, P. / High-sensitivity C-reactive protein for identification of disease phenotype, active disease, and clinical relapses in Crohn's disease : A marker for patient classification?. In: Inflammatory Bowel Diseases. 2012 ; Vol. 18, No. 9. pp. 1647-1654.
@article{cfa9894d388e4a139b1ea5c8c99f1738,
title = "High-sensitivity C-reactive protein for identification of disease phenotype, active disease, and clinical relapses in Crohn's disease: A marker for patient classification?",
abstract = "Background: C-reactive protein (CRP) is a traditional nonspecific marker of inflammation, with Crohn's disease (CD) being associated with a strong CRP response. Thus far, no clear cutoff values have been determined. The authors' aim was to investigate whether high-sensitivity (hs)-CRP is useful for the identification disease phenotype, active disease, and relapse during follow-up, using a classification based on the hs-CRP value at diagnosis. Methods: In all, 260 well-characterized, unrelated, consecutive CD patients (male/female: 120/140; duration: 7.0 ± 6.1 years), with a complete clinical follow-up, were included. Hs-CRP, clinical activity according to the Harvey-Bradshaw Index, and clinical data (disease phenotype according to the Montreal Classification, extraintestinal manifestations, smoking habits, medical therapy, and surgical events) were prospectively collected between January 1, 2008 and June 1, 2010. Medical records prior to the prospective follow-up period were analyzed retrospectively. Results: In all, 32.3{\%} of CD patients had normal hs-CRP at diagnosis. Elevated hs-CRP at diagnosis was associated with disease location (P = 0.002), noninflammatory disease behavior (P = 0.058), and a subsequent need for later azathioprine/biological therapy (P <0.001 and P = 0.024), respectively. The accuracy of hs-CRP for identifying patients with active disease during prospective follow-up was good (area under the curve [AUC]: 0.82, cutoff: 10.7 mg/L). AUC was better in patients with an elevated hs-CRP at diagnosis (AUC: 0.92, cutoff: 10.3 mg/L). In Kaplan-Meier and Cox-regression analyses, hs-CRP was an independent predictor of 3- (P = 0.007) or 12-month (P = 0.001) clinical relapses for patients in remission who had elevated hs-CRP at diagnosis. In addition, perianal involvement (P = 0.01) was associated with the 12-month relapse frequency. Conclusions: Our data suggest that hs-CRP positivity at diagnosis is associated with disease location and behavior, and in patients who are hs-CRP positive at diagnosis, is an accurate marker of disease activity and a predictor of short- and medium-term clinical flare-ups during follow-up.",
keywords = "CD, clinical activity, flare-up, hs-CRP, prediction, risk",
author = "{Sandor Kiss}, Lajos and M. Papp and {Dorottya Lovasz}, Barbara and Zsuzsanna Vegh and {Anna Golovics}, Petra and Eszter Janka and Eva Varga and M. Szathm{\'a}ri and P. Lakatos",
year = "2012",
month = "9",
doi = "10.1002/ibd.21933",
language = "English",
volume = "18",
pages = "1647--1654",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "John Wiley and Sons Inc.",
number = "9",

}

TY - JOUR

T1 - High-sensitivity C-reactive protein for identification of disease phenotype, active disease, and clinical relapses in Crohn's disease

T2 - A marker for patient classification?

AU - Sandor Kiss, Lajos

AU - Papp, M.

AU - Dorottya Lovasz, Barbara

AU - Vegh, Zsuzsanna

AU - Anna Golovics, Petra

AU - Janka, Eszter

AU - Varga, Eva

AU - Szathmári, M.

AU - Lakatos, P.

PY - 2012/9

Y1 - 2012/9

N2 - Background: C-reactive protein (CRP) is a traditional nonspecific marker of inflammation, with Crohn's disease (CD) being associated with a strong CRP response. Thus far, no clear cutoff values have been determined. The authors' aim was to investigate whether high-sensitivity (hs)-CRP is useful for the identification disease phenotype, active disease, and relapse during follow-up, using a classification based on the hs-CRP value at diagnosis. Methods: In all, 260 well-characterized, unrelated, consecutive CD patients (male/female: 120/140; duration: 7.0 ± 6.1 years), with a complete clinical follow-up, were included. Hs-CRP, clinical activity according to the Harvey-Bradshaw Index, and clinical data (disease phenotype according to the Montreal Classification, extraintestinal manifestations, smoking habits, medical therapy, and surgical events) were prospectively collected between January 1, 2008 and June 1, 2010. Medical records prior to the prospective follow-up period were analyzed retrospectively. Results: In all, 32.3% of CD patients had normal hs-CRP at diagnosis. Elevated hs-CRP at diagnosis was associated with disease location (P = 0.002), noninflammatory disease behavior (P = 0.058), and a subsequent need for later azathioprine/biological therapy (P <0.001 and P = 0.024), respectively. The accuracy of hs-CRP for identifying patients with active disease during prospective follow-up was good (area under the curve [AUC]: 0.82, cutoff: 10.7 mg/L). AUC was better in patients with an elevated hs-CRP at diagnosis (AUC: 0.92, cutoff: 10.3 mg/L). In Kaplan-Meier and Cox-regression analyses, hs-CRP was an independent predictor of 3- (P = 0.007) or 12-month (P = 0.001) clinical relapses for patients in remission who had elevated hs-CRP at diagnosis. In addition, perianal involvement (P = 0.01) was associated with the 12-month relapse frequency. Conclusions: Our data suggest that hs-CRP positivity at diagnosis is associated with disease location and behavior, and in patients who are hs-CRP positive at diagnosis, is an accurate marker of disease activity and a predictor of short- and medium-term clinical flare-ups during follow-up.

AB - Background: C-reactive protein (CRP) is a traditional nonspecific marker of inflammation, with Crohn's disease (CD) being associated with a strong CRP response. Thus far, no clear cutoff values have been determined. The authors' aim was to investigate whether high-sensitivity (hs)-CRP is useful for the identification disease phenotype, active disease, and relapse during follow-up, using a classification based on the hs-CRP value at diagnosis. Methods: In all, 260 well-characterized, unrelated, consecutive CD patients (male/female: 120/140; duration: 7.0 ± 6.1 years), with a complete clinical follow-up, were included. Hs-CRP, clinical activity according to the Harvey-Bradshaw Index, and clinical data (disease phenotype according to the Montreal Classification, extraintestinal manifestations, smoking habits, medical therapy, and surgical events) were prospectively collected between January 1, 2008 and June 1, 2010. Medical records prior to the prospective follow-up period were analyzed retrospectively. Results: In all, 32.3% of CD patients had normal hs-CRP at diagnosis. Elevated hs-CRP at diagnosis was associated with disease location (P = 0.002), noninflammatory disease behavior (P = 0.058), and a subsequent need for later azathioprine/biological therapy (P <0.001 and P = 0.024), respectively. The accuracy of hs-CRP for identifying patients with active disease during prospective follow-up was good (area under the curve [AUC]: 0.82, cutoff: 10.7 mg/L). AUC was better in patients with an elevated hs-CRP at diagnosis (AUC: 0.92, cutoff: 10.3 mg/L). In Kaplan-Meier and Cox-regression analyses, hs-CRP was an independent predictor of 3- (P = 0.007) or 12-month (P = 0.001) clinical relapses for patients in remission who had elevated hs-CRP at diagnosis. In addition, perianal involvement (P = 0.01) was associated with the 12-month relapse frequency. Conclusions: Our data suggest that hs-CRP positivity at diagnosis is associated with disease location and behavior, and in patients who are hs-CRP positive at diagnosis, is an accurate marker of disease activity and a predictor of short- and medium-term clinical flare-ups during follow-up.

KW - CD

KW - clinical activity

KW - flare-up

KW - hs-CRP

KW - prediction

KW - risk

UR - http://www.scopus.com/inward/record.url?scp=84865003772&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865003772&partnerID=8YFLogxK

U2 - 10.1002/ibd.21933

DO - 10.1002/ibd.21933

M3 - Article

C2 - 22081542

AN - SCOPUS:84865003772

VL - 18

SP - 1647

EP - 1654

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 9

ER -