eP262 - Predicting the Need for Surgery Among Patients Admitted with Inflammatory Bowel Disease: The Value of C-Reactive Protein

Author(s)

• 

  Alexander A. Xu, MD, MS

  General Surgery Resident
  Lahey Hospital and Medical Center
  Lahey Hospital and Medical Center
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

ePoster Presenter(s)

• 

  Maggie J. McMahon, BA, MS (she/her/hers)

  Medical Student
  Tufts University School of Medicine
  Lahey Hospital and Medical Center
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• CH

  Caroline Hayes, n/a

  Medical Student
  Beth Israel Lahey Hospital, Tufts University School of Medicine
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• 

  Jonathan Abelson, MD MS (he/him/his)

  Staff Surgeon
  Lahey Hospital and Medical Center
  Tufts Medical Center
  ARLINGTON, Massachusetts, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• AK

  Angela H. Kuhnen, MD, MPH, FACS, FASCRS (she/her/hers)

  Fellowship Program Director, Staff surgeon
  Lahey Clinic
  Tufts University School of Medicine
  Burlington, Massachusetts, United States

  Disclosure information not submitted.
• JS

  Julia T. Saraidaridis, MD, MMSc

  Staff Colon and Rectal Surgeon
  Lahey Hospital
  Newton, Massachusetts, United States

  Disclosure information not submitted.
• RP

  Randall Pellish, MD

  Attending Gastroenterologist, Director Lahey Inflammatory Bowel Disease Center
  Lahey Hospital and Medical Center
  Burlington, Massachusetts, United States

  Disclosure information not submitted.
• 

  Peter W. Marcello, MD, FACS, FASCRS (he/him/his)

  Chair, Division of Colon & Rectal Surgery
  Lahey Hospital & Medical Center
  Burlington, Massachusetts, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  David A. Kleiman, MD, MSc, FACS, FASCRS

  Staff Surgeon
  Lahey Hospital & Medical Center
  Melrose, MA, United States

  Disclosure information not submitted.

Purpose/Background: C-reactive protein (CRP) is commonly used to trend the course of various inflammatory conditions, including inflammatory bowel disease (IBD). A markedly elevated CRP may prompt surgical consultation, but the clinical significance of having an elevated CRP on likelihood of needing surgery remains unknown. The aim of this study was to evaluate the predictive value of elevated CRP for discriminating patients who will or will not require surgery for severe IBD.Methods/Interventions: A departmental database was queried to identify all patients who were admitted to a single tertiary referral center for IBD (ulcerative colitis or Crohn’s disease involving either the small bowel or colon) between 2017 and 2022. Multiple hospital admissions for the same patient were included as separate data entry points. Patients were excluded if admitted for elective surgery, as well as patients with non-IBD colitis. The primary endpoint of the study was need for urgent/emergent surgery on that admission, while the secondary endpoint was need for surgery at any point in the future. Demographic and clinical data, including CRP levels throughout the admission, were obtained from the electronic medical record. The spectrum of CRP values was then divided by quartiles, and the predictive value of having a CRP max above the upper quartile was then determined.Results/Outcomes: A total of 189 hospital admissions from 103 unique patients were included in the study. 95 (50.3%) of admissions were for ulcerative colitis while 94 (49.7%) were for Crohn’s disease. 48 (25%) of the admissions resulted in surgery on that admission. 29 (30.5%) and 19 (20.2%) of patients with UC or Crohn’s, respectively, had surgery on that admission (p=0.103). Patients who required surgery on that admission had both a higher admission CRP (93.3 ± 60.6 vs 58.3 ± 61.4, p=0.012) and CRP max prior to surgery (113.8 ± 99.2 vs 75.3 ± 73.1, p=0.008) than those who did not require surgery. The upper quartile of CRP in the study population was 119.0. Having a CRP of 119.0 or higher had a positive predictive value of 35.6% and a negative predictive value of 83.0% for requiring surgery on that admission. However, the positive predictive value of undergoing surgery at any point was 77.8% with a negative predictive value of 33.3%. In univariate analysis, patients with a CRP of 119.0 or higher were 3.5 times more likely to require eventual surgery (95% CI 1.41-8.67, p=0.007).Conclusion/

Discussion: CRP measurement may be a useful tool to identify patients who are at risk of needing urgent surgery, either during a current or future admission. However, many patients with markedly elevated CRP can recover without surgery, which underscores the complexity of the underlying disease and its myriad of clinical presentations. Further study is required to better risk-stratify patients and guide treatment decisions.Table 1: Demographics and Clinical CharacteristicsDemographics and clinical characteristics of inpatients with inflammatory bowel disease