title: Silent Crohn's Disease: Asymptomatic Patients with Elevated C-reactive Protein Are at Risk for Subsequent Hospitalization.
abstract: BACKGROUND
  Patient-reported Crohn's disease (CD) symptoms and endoscopic evaluation have historically guided routine care, but the risk of complications in asymptomatic patients with elevated C-reactive protein (CRP) is unknown.
  
  
  METHODS
  We conducted a prospective observational cohort study of patients with CD from a tertiary care center. Subjects with short inflammatory bowel disease questionnaire scores ≥ 50, Harvey-Bradshaw CD scores ≤ 4, and same-day CRP measurement were eligible for inclusion. The primary outcome was disease-related hospitalization up to 24 months after the qualifying clinic visit. We assessed the relationship between CRP elevation and subsequent hospitalization.
  
  
  RESULTS
  There were 351 asymptomatic patients with CD (median age 40 yr; 50.4% female) who met inclusion criteria, and CRP was elevated in 19.7% of these individuals (n = 69). At 24 months, 16.8% (n = 59) of the study population had been hospitalized for CD-related complications. Significantly, more patients with an elevated CRP were hospitalized (33.3% versus 12.8%, P < 0.0001) compared with those with a normal CRP and were hospitalized at increased rate (P < 0.001) on Kaplan-Meier analysis. CRP elevation was significantly and independently associated with increased risk of hospitalization (adjusted hazard ratio 2.12; 95% confidence interval, 1.13-3.98; P = 0.02) in multivariable survival analysis.
  
  
  CONCLUSIONS
  Asymptomatic patients with CD with elevated CRP are at a nearly 2-fold higher risk for hospitalization over the subsequent 2 years compared with asymptomatic patients with CD without CRP elevation.
authors.affiliation: *Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; †Division of Colorectal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ‡Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; and §Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Click
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Vargas
authors.forename: Alyce M
authors.initials: AM
authors.lastname: Anderson
authors.forename: Siobhan
authors.initials: S
authors.lastname: Proksell
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Koutroubakis
authors.forename: Claudia
authors.initials: C
authors.lastname: Ramos Rivers
authors.forename: Jana G
authors.initials: JG
authors.lastname: Hashash
authors.forename: Miguel
authors.initials: M
authors.lastname: Regueiro
authors.forename: Andrew
authors.initials: A
authors.lastname: Watson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dunn
authors.forename: Marc
authors.initials: M
authors.lastname: Schwartz
authors.forename: Jason
authors.initials: J
authors.lastname: Swoger
authors.forename: Leonard
authors.initials: L
authors.lastname: Baidoo
authors.forename: Arthur
authors.initials: A
authors.lastname: Barrie
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D002097:C-Reactive Protein / Q000032:analysis*; D003424:Crohn Disease / Q000097:blood*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D002097:C-Reactive Protein