Clinical Features of Intra-Abdominal Abscess and Intestinal Free-Wall Perforation in Korean Patients with Crohn’s Disease: Results from the CONNECT Study

Jeong, So‐Yeon; Choi, June Seek; Kim, Jin Woo; Kim, Hee Man; Kim, Hyun Soo; Im, Jong Pil; Kim, Sang Woo; Kim, You Sun; Cheon, Jae Hee; Ye, Byong Duk; Kim, Young Ho; Han, Dong Soo

doi:10.3390/jcm10010116

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…Patients with an IA were younger than control patients, a finding also demonstrated in a recent nationwide study. 24 We did not find an association between sex or comorbidities to an IA.…”

Section: Discussioncontrasting

confidence: 53%

Machine learning for prediction of intra-abdominal abscesses in patients with Crohn’s disease visiting the emergency department

Levartovsky

Barash

Ben‐Horin

et al. 2021

Therap Adv Gastroenterol

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Background: Intra-abdominal abscess (IA) is an important clinical complication of Crohn’s disease (CD). A high index of clinical suspicion is needed as imaging is not routinely used during hospital admission. This study aimed to identify clinical predictors of an IA among hospitalized patients with CD using machine learning. Methods: We created an electronic data repository of all patients with CD who visited the emergency department of our tertiary medical center between 2012 and 2018. We searched for the presence of an IA on abdominal imaging within 7 days from visit. Machine learning models were trained to predict the presence of an IA. A logistic regression model was compared with a random forest model. Results: Overall, 309 patients with CD were hospitalized and underwent abdominal imaging within 7 days. Forty patients (12.9%) were diagnosed with an IA. On multivariate analysis, high C-reactive protein (CRP) [above 65 mg/l, adjusted odds ratio (aOR): 16 (95% CI: 5.51–46.18)], leukocytosis [above 10.5 K/μl, aOR: 4.47 (95% CI: 1.91–10.45)], thrombocytosis [above 322.5 K/μl, aOR: 4.1 (95% CI: 2–8.73)], and tachycardia [over 97 beats per minute, aOR: 2.7 (95% CI: 1.37–5.3)] were independently associated with an IA. Random forest model showed an area under the curve of 0.817 ± 0.065 with six features (CRP, hemoglobin, WBC, age, current biologic therapy, and BUN). Conclusion: In our large tertiary center cohort, the machine learning model identified the association of six clinical features (CRP, hemoglobin, WBC, age, BUN, and biologic therapy) with the presentation of an IA. These may assist as a decision support tool in triaging CD patients for imaging to exclude this potentially life-threatening complication.

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“…Patients with an IA were younger than control patients, a finding also demonstrated in a recent nationwide study. 24 We did not find an association between sex or comorbidities to an IA.…”

Section: Discussioncontrasting

confidence: 53%

Machine learning for prediction of intra-abdominal abscesses in patients with Crohn’s disease visiting the emergency department

Levartovsky

Barash

Ben‐Horin

et al. 2021

Therap Adv Gastroenterol

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“…International guidelines recommend intravenous antibiotic therapy and therapeutic (percutaneous) drainage if abscess formation exceeds 3 cm in diameter [ 6 , 9 , 10 , 11 ]. So far, empiric antibiotic therapy included a combination of metronidazole with fluoroquinolones or third generation cephalosporins [ 6 , 18 ], but these recommendations are mainly based on case series and retrospective monocentric data, respectively [ 15 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. In line with that, a recently published multicentric prospective European study evaluating the microbial spectrum of intra-abdominal abscess formation in patients suffering from Crohn´s disease demonstrated a high rate of inadequate antimicrobial empirical first-line therapy [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Kusan

Surat

Kelm

et al. 2022

JCM

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Intraabdominal abscess formation occurs in up to 30% of patients suffering from Crohn´s disease (CD). While international guidelines recommend a step-up approach with a combination of empiric antibiotic therapy and percutaneous drainage to delay or even avoid surgery, evidence about microbial spectrum in penetrating ileitis is sparse. We retrospectively assessed outcomes of 46 patients with terminal penetrating Ileitis where microbial diagnostics have been performed and compared microbial spectrum and antibiotic resistance profile of CD patients with patients suffering from diverticulitis with intraabdominal abscess formation. In both groups, the most frequently isolated pathogen was the gram-negative bacterium E. coli belonging to the family of Enterobacterales. However, overall Enterobacterales were significantly more often verifiable in the control group than in CD patients. Furthermore, microbial analysis showed significant differences regarding isolation of anaerobic pathogens with decreased frequency in patients with CD. Subgroup analysis of CD patients to evaluate a potential influence of immunosuppressive therapy on microbial spectrum only revealed that Enterobacterales was less frequently detected in patients treated with steroids. Immunosuppressive therapy did not show any impact on all other groups of pathogens and did not change antibiotic resistance profile of CD patients. In conclusion, we were able to demonstrate that the microbial spectrum of CD patients does differ only for some pathogen species without increased rate of antibiotic resistance. However, the empiric antibiotic therapy for CD-associated intra-abdominal abscess remains challenging since different points such as local epidemiological and microbiological data, individual patient risk factors, severity of infection, and therapy algorithm including non-surgical and surgical therapy options should be considered before therapeutical decisions are made.

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“…However, in another study, researchers found that prestenotic bowel dilation of 30 mm or more was associated with surgery [12]. In a Korean cohort, the presence of intestinal stricture at development after diagnosis increased the risk of IAA and intestinal free-wall perforation [14]. More attention should be focused on bowel stenosis and bowel dilation in future studies.…”

Section: Discussionmentioning

confidence: 93%

Predictors for Invasive Therapy in the Management of Crohn’s Disease-related Spontaneous Intra-abdominal Abscess: Prognosis and Long-term Follow-up

Sun

Liu

et al. 2023

Preprint

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Background Decision-making in the management of Crohn’s disease (CD)-related spontaneous intra-abdominal abscess (IAA) is challenging. This study aims to reveal predictive factors for percutaneous drainage and/or surgery in the treatment of CD-related spontaneous IAA through long-term follow-up. Methods Data were collected, including clinical manifestations, radiography and treatment strategies, in Chinese patients with CD-related IAA in a tertiary medical center from Jan 2014 to Dec 2017. A Cox proportional hazards regression model was used to identify predictors for invasive therapy, which were incorporated together to develop a prognostic nomogram. Validation of the nomogram was assessed by a separate cohort of patients with CD-related IAA from Jan 2018 to Mar 2021. Results Altogether, 33 CD patients were identified as having IAA through enhanced CT scans. The median follow-up time was 52.0 (33.5, 60.0) months. Eighteen (54.5%) patients underwent conservative medical treatment, and 15 (45.5%) patients underwent percutaneous drainage and/or surgical intervention (invasive treatment group). The 1-, 2-, and 5-year overall survival rates without invasive treatment were 69.7%, 57.3%, and 53.7%, respectively. On univariate Cox analysis, nonperienteric abscess (HR: 6.391, 95% CI: 1.970-20.728, p = 0.002), max abscess diameter (HR: 1.015, 95% CI: 1.005–1.025, p = 0.003) and width of sinus (HR: 1.246, 95% CI: 1.037–1.498, p = 0.019) were significantly associated with worse OS without invasive treatment. Nonperienteric abscess was significantly associated with worse OS without invasive treatment on multivariate Cox analysis (HR: 5.738, 95% CI: 1.763–18.672, p = 0.004). These factors were incorporated together to develop a prognostic nomogram and were externally confirmed in the validation cohort. The concordance index was 0.842 (95% CI: 0.681–0.983, p < 0.001). Conclusions Nonperienteric abscesses indicate a more aggressive treatment strategy, such as percutaneous drainage and/or surgery, in the management of CD-related IAA. A nomogram could help recognize patients who are more likely to require invasive treatment.

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Clinical Features of Intra-Abdominal Abscess and Intestinal Free-Wall Perforation in Korean Patients with Crohn’s Disease: Results from the CONNECT Study

Cited by 7 publications

References 32 publications

Machine learning for prediction of intra-abdominal abscesses in patients with Crohn’s disease visiting the emergency department

Machine learning for prediction of intra-abdominal abscesses in patients with Crohn’s disease visiting the emergency department

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Predictors for Invasive Therapy in the Management of Crohn’s Disease-related Spontaneous Intra-abdominal Abscess: Prognosis and Long-term Follow-up

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