Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea.
World J Gastroenterol. 2021 May 21;27(19):2353-2365. doi: 10.3748/wjg.v27.i19.2353.
Acute severe lower gastrointestinal bleeding (LGIB) is an uncommon but challenging complication of Crohn's disease (CD).
To identify the predictors of acute severe LGIB and to evaluate the impact of acute severe LGIB on the subsequent clinical course in CD patients.
A retrospective inception cohort study was conducted in 75 CD patients with acute severe LGIB and 1359 CD patients without acute severe LGIB who were diagnosed between February 1991 and November 2019 at Asan Medical Center, a tertiary university hospital in Korea. Multivariable analysis with Cox proportional hazard regression was performed to identify the risk factors for acute severe LGIB. A matched analysis using 72 patients with bleeding and 267 matched patients without within the cohort was also conducted to investigate whether acute severe LGIB is a predictor of clinical outcomes of CD.
Multivariable Cox regression analysis revealed that early use of thiopurines [hazard ratio (HR): 0.23, 95% confidence interval (CI): 0.12-0.48; 0.001] and female sex (HR: 0.51, 95%CI: 0.27-0.94; 0.031) were significantly associated with a lower risk of acute severe LGIB. The cumulative risks of behavioral progression and intestinal resection were not significantly different between the two matched groups ( 0.139 and 0.769, respectively). The hospitalization rate was higher in the bleeding group than in the matched non-bleeding group (22.1/100 13.2/100 patient-years; = 0.012). However, if hospitalizations due to bleeding episodes were excluded from the analysis, the hospitalization rate was not significantly different between the bleeding group and the matched non-bleeding group (14.5/100 13.2/100 patient-years; = 0.631).
Early use of thiopurines may reduce the risk of acute severe LGIB. History of acute severe LGIB may not have a significant prognostic value in patients with CD.
急性重度下消化道出血（LGIB）是克罗恩病（CD）的一种罕见但具有挑战性的并发症。
确定急性重度 LGIB 的预测因素，并评估其对 CD 患者后续临床病程的影响。
对 1991 年 2 月至 2019 年 11 月期间在韩国的一家三级大学医院—— 首尔峨山医学中心诊断为急性重度 LGIB 的 75 例 CD 患者和未发生急性重度 LGIB 的 1359 例 CD 患者进行了回顾性队列研究。采用 Cox 比例风险回归的多变量分析来确定急性重度 LGIB 的危险因素。对队列中 72 例出血患者和 267 例匹配无出血患者进行匹配分析，以探讨急性重度 LGIB 是否是 CD 临床结局的预测因素。
多变量 Cox 回归分析显示，早期使用硫嘌呤（HR：0.23，95%CI：0.12-0.48； 0.001）和女性（HR：0.51，95%CI：0.27-0.94； 0.031）与急性重度 LGIB 的风险降低显著相关。两组匹配患者的行为进展和肠切除术的累积风险无显著差异（分别为 0.139 和 0.769）。出血组的住院率高于匹配的无出血组（22.1/100 13.2/100 患者年； = 0.012）。然而，如果从分析中排除因出血发作而住院的情况，则出血组与匹配的无出血组的住院率无显著差异（14.5/100 13.2/100 患者年； = 0.631）。
早期使用硫嘌呤可能降低急性重度 LGIB 的风险。在 CD 患者中，急性重度 LGIB 的病史可能没有显著的预后价值。
