C-reactive protein is associated with postoperative outcomes in patients with intestinal Behçet’s disease

Abstract

Background Patients with intestinal Behçet’s disease (BD) frequently undergo intestinal resections, which significantly affects postoperative morbidity and mortality. The aim of this study was to identify the association between C-reactive protein (CRP) levels and postoperative outcomes in patients with intestinal BD who underwent surgical bowel resection. Methods Patients who were diagnosed with intestinal BD and underwent intestinal surgery due to BD at Severance Hospital between November 2005 and April 2018 were retrospectively investigated. Clinical relapse was defined as a disease activity index of BD (DAIBD) > 40, existence of newly added medications, re-hospitalization, or re-operation related to intestinal BD. The relationship between CRP level and postoperative outcomes was analyzed, and a receiver operating characteristic (ROC) curve was drawn to specify a cut-off value. Results Ninety patients with intestinal BD were included. Among them, 44 were male (48.9%), and the median age at diagnosis was 38 years (range, 11–69 years). The median total disease follow-up duration was 130 months (range, 3–460 months). Forty patients (44.4%) underwent laparoscopic surgery. A higher CRP level immediately after surgery was significantly associated with postoperative complications (OR 1.01, 95% CI 1.004–1.018, p < 0.01), re-operation (hazard ratio [HR] 1.01, 95% CI 1.005–1.020, p < 0.01), and re-admission (HR 1.01, 95% CI 1.006–1.017 p < 0.01). The ROC curve showed that CRP predicts the risk of postoperative complications (p < 0.01) at a cut-off value of 41.9% with a sensitivity of 60.0% and specificity of 67.7%. Conclusions Postoperative CRP levels in patients with intestinal BD undergoing surgical resection were associated with postoperative outcomes.

Intestinal Behçet's disease: A review of clinical diagnosis and treatment

“…Additionally, multicenter collaborations should further explore and refine prognostic risk factor assessment for intestinal BD through retrospective and prospective studies. Elevated CRP levels associate with surgical recurrence at various time points[ 67 , 69 ], so real-time CRP inflammatory marker monitoring before, during, and after surgery may aid real-time management of intestinal BD. These efforts could enable risk-stratified, tailored drug therapies and personalized patient monitoring.…”

“…Postoperative complications, including anastomotic leak, abscess or fistula formation, wound infection, intestinal obstruction, bleeding, and perforation, can significantly impact recovery of patients with intestinal BD. Elevated CRP levels immediately postoperatively significantly increase risk of postoperative complications[ 67 ]. Combined use of glucocorticoids and immunosuppressants postoperatively can significantly reduce incidence of postoperative complications[ 68 ].…”

“…As shown in Table 1 , various factors influence intestinal BD prognosis post-surgery. Among these, elevated CRP levels identified by Kang et al [ 67 ] and Jung et al [ 69 ], and emergency surgery identified by Park et al [ 70 ], are poor postoperative prognostic factors in intestinal BD. These findings are consistent with the results of the current study by Park et al [ 25 ].…”

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…Case reports on both type 1 and type 2 autoimmune pancreatitis revealed increased CRP levels in remission and flares, but further observational data are still absent [ 692 , 693 ]. Furthermore, a recent study concluded that elevated CRP is associated with active Behcet’s disease, which, in reality, is not characterized by specific autoantibodies, and another study found that postoperative CRP levels in those cases with intestinal issues undergoing surgical resection were linked to postoperative outcomes [ 694 , 695 ]. A study revealed that CRP can be elevated in Celiac disease yet with no significant differences between complicated and uncomplicated cases [ 696 ].…”