title: Intestinal Dilation and Platelet:Albumin Ratio Are Predictors of Surgery in Stricturing Small Bowel Crohn's Disease.
abstract: It is a challenge to predict how patients with small bowel Crohn's disease (CD) will respond to intensified medical therapy. We aimed to identify factors that predicted surgery within 2 years of hospitalization for CD, to guide medical versus surgical management decisions.
  
  
  
  We performed a retrospective review of adults hospitalized for small bowel CD from 2004 through 2012 at a single academic referral center. Subjects underwent abdominal computed tomography or magnetic resonance imaging within 3 weeks of hospitalization. Imaging characteristics of small bowel dilation, bowel wall thickness, and disease activity were assessed by a single, blinded radiologist. Multivariate analysis by Cox proportional hazards regression techniques was used to generate a prediction model of intestinal resection within 2 years.
  
  
  
  A total of 221 subjects met selection criteria, with 32.6% undergoing surgery within 2 years of index admission. Bivariate analysis showed high-dose steroid use (>40 mg), ongoing treatment with anti-tumor necrosis factor agents at admission, platelet count, platelet:albumin ratio, small bowel dilation (≥35 mm), and bowel wall thickness to predict surgery (P ≤ .01). Multivariate modeling demonstrated small bowel dilation >35 mm (hazard ratio, 2.92; 95% confidence interval, 1.73-4.94) and a platelet:albumin ratio ≥125 (hazard ratio, 2.13; 95% confidence interval, 1.15-3.95) to predict surgery. Treatment with anti-tumor necrosis factor agents at admission conferred a nonsignificant increased trend for risk of surgery (hazard ratio, 1.61; 95% confidence interval, 0.994-2.65).
  
  
  
  Small bowel dilation >35 mm and high platelet:albumin ratios are independent and synergistic risk factors for future surgery in patients with structuring small bowel CD. Platelet:albumin ratios may capture the relationship between acute inflammation and cumulative damage and serve as markers of intestinal disease that cannot be salvaged with medical therapy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: ryanstid@med.umich.edu.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Stidham
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Guentner
authors.affiliation: Department of Radiology, Veterans Affairs Health System, Ann Arbor, Michigan.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Ruma
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; VA Ann Arbor Health Services Research & Development Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Shail M
authors.initials: SM
authors.lastname: Govani
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; VA Ann Arbor Health Services Research & Development Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Peter D R
authors.initials: PD
authors.lastname: Higgins
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D003661:Decision Support Techniques; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D000075462:Serum Albumin, Human; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: C422455:ALB protein, human; D012709:Serum Albumin; D000075462:Serum Albumin, Human
keywords: Bowel Obstruction; Outcome; Predictive Model; TNF