Early predictors of the life-threatening complications of inflammatory bowel diseases: the retrospective cohort study results

Abstract

Introduction. Ulcerative colitis and Crohn’s disease belong to the inflammatory bowel diseases (IBD) and are one of the most urgent problems of gastroenterology worldwide, including due to frequent recurrence and development of specific complications. The aim of the study was to identify predictors of the development of life-threatening complications of IBD. Materials and Methods. A retrospective cohort study was conducted, 250 patients with ulcerative colitis and 266 patients with Crohn’s disease were included, they were observed in the specialized IBD city clinic in St. Petersburg, Russia. Demographic features of the patient’s cohort, clinical characteristics of the disease and the therapy used were assessed. The studied outcome was the development of the chronologically first life-threatening complication in the history of the disease. Data analysis included basic statistical methods, Kaplan-Meier survival analysis and Cox regression. Results. The median duration of patient follow-up from the moment of diagnosis was 2.5 years for ulcerative colitis and 2 years for Crohn’s disease. The incidence of life-threatening complications in ulcerative colitis was 8.0%, in Crohn’s disease - 28.2%. In ulcerative colitis, the predominant life-threatening complication was severe anemia requiring hemotransfusion, whereas in Crohn’s disease, complete intestinal stricture and intestinal perforation were the most common complications as a severe anemia. Only 59% of cases of life-threatening complications of IBD occurred after this diagnosis was established, while in 29% of cases they developed at the disease onset and became the reason for the IBD diagnosis, and in 12% of patients even the development of a life-threatening complication did not become the reason for the IBD diagnosis. As a result of multivariate Cox regression analysis, independent factors (predictors) of the development of life-threatening complications of IBD were identified: in Crohn’s disease, therapy with 5-aminosalicylic acid (5-ASA) and/or corticoids alone (RR 9.4; 95% CI 2.9-30.5) and a continuously recurrent or acute course of the disease (RR 3.0; 95% CI 1.1-8.3), and for ulcerative colitis, 5-ASA monotherapy (RR 28.0; 95% CI 2.0-401.0), a continuously recurrent or acute course of disease (OR 26.2; 95% CI 3.2-215.4), and a history of non-life-threatening complications (RR 7.7; 95% CI 1.5-39.8). Conclusion. To prevent the life-threatening complications development, both timely diagnosis of IBD and active specific therapy aimed at achieving and maintaining long-term remission of the disease are necessary. The presence of the above-mentioned predictors of life-threatening complications of ulcerative colitis and Crohn’s disease can be considered as a basis for intensification of IBD therapy using immunosuppressors, targeted immunosuppressors and biologics, taking into account a personalized approach to therapy of IBD patients.

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