A simple biological score for predicting low risk of short-term relapse in Crohn's disease.
BACKGROUND
In Crohn's disease, studies have evaluated the ability of biological markers to predict relapse in the next 12 to 18 months, without differentiating early from late relapses. The aim of this study was to look for biological markers of short-term relapse.


METHODS
In a previous therapeutic trial, patients with a medically induced clinical remission had biological markers evaluated and updated every 6 weeks. A Cox model with time-dependent covariates was used for analysis.


RESULTS
Among the 71 patients, 38 had a relapse. Multivariate analysis selected 2 markers predictive of relapse: C-reactive protein >20 mg/L and erythrocyte sedimentation rate >15 mm. A binary biological predictive score was derived: "negative" when both were lower than their limits, "positive" when otherwise. The relative risk of short-term relapse for patients with a positive score compared to those with a negative score was 8.0 (95% confidence interval 2.8-22.9). Sensitivity of the score was 89% and specificity was 43%. Assuming a 10% relapse rate every 6 weeks, negative and positive predictive values were 97% and 15%, respectively.


CONCLUSIONS
This simple biological score can predict short-term maintenance of remission in Crohn's disease and may help physicians in the follow-up of patients in clinical remission.
Consigny
Yann
Y
Unité de Biostatistique et Epidémiologie Clinique, INSERM U 717, Université Paris 7, Paris, France.
Modigliani
Robert
R
Colombel
Jean-Frédéric
JF
Dupas
Jean-Louis
JL
Lémann
Marc
M
Mary
Jean-Yves
JY
D000328:Adult; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D004311:Double-Blind Method; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012306:Risk; D012680:Sensitivity and Specificity; D013997:Time Factors
D002097:C-Reactive Protein