Baseline Clinical Factors Are Associated With Risk of Complications in Crohn's Disease: Appraisal of the American Gastroenterological Association Clinical Care Pathway.

Autor:	Santiago P; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Coelho-Prabhu N; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Lennon R; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA., Rui S; The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Rajauria P; The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Friton J; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Raffals LE; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Deepali F; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Daoud N; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Farraye FA; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Tuck J; Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA., Malik T; Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA., Leleiko NS; Division of Pediatric Gastroenterology, Department of Pediatrics, Columbia University Medical Center, New York, New York, USA., Shapiro J; Department of Pediatric Gastroenterology, Warren Alpert Medical School of Brown University, Providence., Shah SA; Division of Gastroenterology, Warren Alpert Medical School of Brown University, Providence., Sands BE; The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Ungaro RC; The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2024 Jan 01; Vol. 119 (1), pp. 147-154. Date of Electronic Publication: 2023 Sep 15.
DOI:	10.14309/ajg.0000000000002498
Abstrakt:	Introduction: The American Gastroenterological Association (AGA) has compiled risk factors that may be predictive of disease complications in Crohn's disease (CD) and ulcerative colitis (UC). The aim of this study was to evaluate the performance of the AGA risk factors for risk stratification in UC and CD. Methods: We included participants of 2 cohorts: the Ocean State Crohn's and Colitis Area Registry cohort and the Mayo Clinic cohort. Baseline clinical risk factors were extracted according to the AGA pathway. Our primary end point was defined as follows: (i) any inflammatory bowel disease related-hospitalization, (ii) any inflammatory bowel disease-related bowel surgery, or (iii) any progression of disease. We analyzed the association of the number of AGA risk factors with our end point. Statistical multivariable modeling was performed with Cox proportional hazards model. Results: A total of 412 patients with CD were included. Comparing ≥3 risk factors with 0-1 risk factor, we found a significantly increased risk of complications in both the Ocean State Crohn's and Colitis Area Registry cohort (hazard ratio [HR] 2.75, 95% confidence interval 1.71-4.41) and Mayo Clinic cohort (HR 2.07, 95% confidence interval 1.11-3.84). Diagnosis at younger age (HR 2.07), perianal disease (HR 1.99), and B2/B3 behavior (HR 1.92) were significantly associated with disease complications. We did not observe a consistent association between number of risk factors nor any specific individual risk factors and risk of disease complications in the 265 patients with UC included. Discussion: We found a significant association between the number of AGA risk factors and the risk of disease complication in CD; this association was not significant in UC. The presence of ≥ 3 risk factors in CD leads to the highest risk of complications. The AGA care pathway is a useful tool to stratify patients who are at higher risk of disease complications in patients with CD. (Copyright © 2023 by The American College of Gastroenterology.)
Databáze:	MEDLINE
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