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BACKGROUND
Previous studies have evaluated the ability of biological markers to detect disease relapse in Crohn's disease (CD). Yet no studies have targeted a method to anticipate recurrence after surgical resection. C-Reactive Protein (CRP) is a valuable marker for predicting the outcome of several diseases including CD. The exact role of CRP as a prognostic factor for future recurrence in CD is not yet determined. Moreover no data are available investigating specific CRP modifications in these patients following surgery.
Objective of present study was to determine the perioperative behaviour of the CRP in CD patients undergoing elective ileo-cecal resection. Our hypothesis is that perioperative CRP changes are disease-specific and therefore could detect subset of patient with more aggressive disease. Secondary objective was to investigate the role of CRP as a potential early prognostic marker for future recurrence.
METHODS
52 patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed perioperatively: time 0, postoperative day (POD) 1 and POD 6. CD patients' perioperative CRP findings were compared against same interval assessments of two control groups undergoing right colectomy and appendicectomy. Crohn's Disease Activity Index (CDAI) and Rutgeerts' score (RS) were evaluated for recurrence during 3 year follow-up protocol.
RESULTS
As expected, in all 3 groups CRP significantly increased 24 hours after surgery vs baseline but the increase was significantly higher in CD patients than in controls (p < 0.001). Comparing to control groups CRP remained remarkably high in CD (mean 32.2mg/L) at POD 6. Difference between groups was statistical significant (p 0.03). All CD patients evaluated at 3 year follow up were in clinical remission. Endoscopic recurrence (RS >2) was found in 51% at 1 year and in 42% at 3 years. Possible relation between endoscopic recurrence rate or severity and perioperative CRP levels was investigated: multivariate ordinal regression showed that postoperative increment of CRP is a prognostic factor of recurrence at 3 years.
CONCLUSION
Present preliminary data show disease-specific perioperative CRP levels for CD patients that reflect immunomodulation impairment involved in disease etiology. The degree of such immunitary change and consequent severity of disease might be explored early after surgery by determining CRP alterations. Data from larger series can confirm that perioperative CRP levels might be considered a novel prognostic factors of surgical recurrence.