C-reactive protein: a predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study

Henriksen, M.; Jahnsen, J.; Lygren, I.; Stray, N.; Sauar, J.; Vatn, M. H.; Mourn, B.
November 2008
Gut;Nov2008, Vol. 57 Issue 11, p1518
Academic Journal
Background and aims: C-reactive protein (CAP) levels are often used in the follow-up of patients with inflammatory bowel disease (IBD). The aims of this study were to establish the relationship of CRP levels to disease extent in patients with ulcerative colitis and to phenotype in patients with Crohns disease, and to investigate the predictive value of CAP levels for disease outcome. Methods: CAP was measured at diagnosis and after 1 and 5 years in patients diagnosed with IBD in southeastern Norway. After 5 years, 454 patients with ulcerative colitis and 200 with Crohns disease were alive and provided sufficient data for analysis. Results: Patients with Crohn's disease had a stronger CAP response than did those with ulcerative colitis. In patients with ulcerative colitis, CAP levels at diagnosis increased with increasing extent of disease. No differences in CAP levels at diagnosis were found between subgroups of patients with Crohns disease as defined according to the Vienna classification. In patients with ulcerative colitis with extensive colitis, CAP levels above 23 mg/I at diagnosis predicted an increased risk of surgery (odds ratio (OA) 4.8, 95% confidence interval (CI) 1.5 to 15.1, p = 0.02). In patients with ulcerative colitis, CAP levels above 10 mg/I after 1 year predicted an increased risk of surgery during the subsequent 4 years (OA 3.0, 95% Cl 1.1 to 7.8, p = 0.02). A significant association between CAP levels at diagnosis and risk of surgery was found in patients with Crohn's disease and terminal ileitis (Li), and the risk increased when CAP levels were above 53 mg/I in this subgroup (OA 6.0, 95% Cl 1.1 to 31.9, p = 0.03). Conclusions: CAP levels at diagnosis were related to the extent of disease in patients with ulcerative colitis. Phenotype had no influence on CAP levels in patients with Crohn's disease. CAP is a predictor of surgery in subgroups of patients with either ulcerative colitis or Crohn's disease.


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