title: Risk and management of intra-abdominal abscess in Crohn's disease treated with infliximab.
abstract: OBJECTIVE
  Infliximab (IFX) is a monoclonal antibody used to treat patients with Crohn's disease (CD). Intra-abdominal abscess formation is a major complication of CD with negative effects on patient prognosis. We have analyzed risk factors for abscess formation in CD patients treated with IFX.
  
  
  METHODS
  CD patients who received IFX between January 2000 and April 2011 at Keio University Hospital were analyzed retrospectively. Risk factors for abscess formation were assessed by univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  Intra-abdominal abscess was seen in 15 of 258 patients. Univariate analyses showed serum C-reactive protein (CRP) concentration at 14 weeks after initiation of IFX (p = 0.021), serum albumin concentration at week 0 (p = 0.022) and week 14 (p = 0.004), the presence of anal lesions (p = 0.036), progression of intestine deformation (p = 0.015) and early loss of response to IFX (p < 0.0001) to be risk factors. Multivariate analysis showed that CRP concentration at 14 weeks [odds ratio (OR) 1.361] and loss of IFX response within 6 months (OR 5.361) were independent risk factors.
  
  
  CONCLUSIONS
  Abscess formation should be suspected in patients with symptoms of CD recurrence during IFX therapy. Uncontrolled CRP concentration and early loss of response to IFX are risk factors.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yoneno
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hisamatsu
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Matsuoka
authors.forename: Susumu
authors.initials: S
authors.lastname: Okamoto
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Takayama
authors.forename: Riko
authors.initials: R
authors.lastname: Ichikawa
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Sujino
authors.forename: Jun
authors.initials: J
authors.lastname: Miyoshi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takabayashi
authors.forename: Yohei
authors.initials: Y
authors.lastname: Mikami
authors.forename: Shinta
authors.initials: S
authors.lastname: Mizuno
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Wada
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yajima
authors.forename: Makoto
authors.initials: M
authors.lastname: Naganuma
authors.forename: Nagamu
authors.initials: N
authors.lastname: Inoue
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab