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Real-World Surgical and Endoscopic Recurrence Based on Risk Profiles and Prophylaxis Utilization in Postoperative Crohn's Disease.
Shah, Ravi S; Bachour, Salam; Joseph, Abel; Xiao, Huijun; Lyu, Ruishen; Syed, Hareem; Li, Terry; Pothula, Shravya; Vinaithirthan, Vall; Ali, Adel Hajj; Contreras, Sussel; Hu, Jessica H; Barnes, Edward L; Axelrad, Jordan E; Holubar, Stefan D; Regueiro, Miguel; Cohen, Benjamin L; Click, Benjamin H.
Afiliación
  • Shah RS; Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio.
  • Bachour S; Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
  • Joseph A; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
  • Xiao H; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
  • Lyu R; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
  • Syed H; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
  • Li T; Department of Medicine, New York University Grossman School of Medicine, New York, New York.
  • Pothula S; Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
  • Vinaithirthan V; University of Colorado School of Medicine, Aurora, Colorado.
  • Ali AH; Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
  • Contreras S; Department of Gastroenterology and Hepatology, New York University, New York, New York.
  • Hu JH; University of North Carolina School of Medicine, Chapel Hill, North Carolina.
  • Barnes EL; Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina.
  • Axelrad JE; Department of Gastroenterology and Hepatology, New York University, New York, New York.
  • Holubar SD; Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio.
  • Regueiro M; Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio.
  • Cohen BL; Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio.
  • Click BH; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado. Electronic address: Benjamin.click@cuanschutz.edu.
Clin Gastroenterol Hepatol ; 22(4): 847-857.e12, 2024 Apr.
Article en En | MEDLINE | ID: mdl-37879523
BACKGROUND & AIMS: Preoperative risk stratification may help guide prophylactic biologic utilization for the prevention of postoperative Crohn's disease (CD) recurrence; however, there are limited data exploring and validating proposed clinical risk factors. We aimed to explore the preoperative clinical risk profiles, quantify individual risk factors, and assess the impact of biologic prophylaxis on postoperative recurrence risk in a real-world cohort. METHODS: In this multicenter retrospective analysis, patients with CD who underwent ileocolonic resection (ICR) from 2009 to 2020 were identified. High-risk (active smoking, ≥2 prior surgeries, penetrating disease, and/or perianal disease) and low-risk (nonsmokers and age >50 y) features were used to stratify patients. We assessed the risk of endoscopic (Rutgeert score, ≥i2b) and surgical recurrence by risk strata and biologic prophylaxis (≤90 days postoperatively) with logistic and time-to-event analyses. RESULTS: A total of 1404 adult CD patients who underwent ICR were included. Of the high-risk factors, 2 or more ICRs (odds ratio [OR], 1.71; 95% CI, 1.13-2.57), active smoking (OR, 1.73; 95% CI, 1.17-2.53), penetrating disease (OR, 1.41; 95% CI, 1.02-1.94), and history of perianal disease alone (OR, 1.99; 95% CI, 1.42-2.79) were associated with surgical but not endoscopic recurrence. Surgical recurrence was lower in high-risk patients receiving prophylaxis vs not (10.2% vs 16.7%; P = .02), and endoscopic recurrence was lower in those receiving prophylaxis irrespective of risk strata (high-risk, 28.1% vs 37.4%; P = .03; and low-risk, 21.1% vs 38.3%; P = .002). CONCLUSIONS: Clinical risk factors accurately illustrate patients at risk for surgical recurrence, but have limited utility in predicting endoscopic recurrence. Biologic prophylaxis may be of benefit irrespective of risk stratification and future studies should assess this.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Productos Biológicos / Enfermedad de Crohn Límite: Adult / Humans Idioma: En Revista: Clin Gastroenterol Hepatol Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Productos Biológicos / Enfermedad de Crohn Límite: Adult / Humans Idioma: En Revista: Clin Gastroenterol Hepatol Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos