Cohen Nathaniel A, Kliper Efrat, Zamstein Noa, Ziv-Baran Tomer, Waterman Matti, Hodik Gabriel, Tov Amir Ben, Kariv Revital
Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, 6 Weizmann Street, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dig Dis Sci. 2023 Feb;68(2):414-422. doi: 10.1007/s10620-022-07714-2. Epub 2022 Oct 11.
Few data describing pre-diagnosis changes in patients with inflammatory bowel disease (IBD) exist. We aimed to determine if there is a pattern of change in use of health resources, medications and laboratory results in the years preceding diagnosis.
This retrospective study used electronic medical records of Maccabi Health Services (MHS). Patients with IBD ≥ 16 years of age and minimum of 5-years follow-up were identified by entry into the MHS IBD registry and included in the analysis. Demographic, clinical, medication and laboratory data were collected. Generalized estimating equation model was applied to study trends and compare between years.
This study included 5643 patients with IBD. Of these, 3039 (53.8%) had Crohn's disease (CD), 2322 (41.1%) had ulcerative colitis (UC) and 282 (5%) had indeterminate colitis (IC). Laboratory parameters including white blood cells, platelets and C-reactive protein showed significant increases while haemoglobin and mean cell volume showed significant decreases in mean values in the 2 years prior to diagnosis with stable values prior to that (p < 0.0001). Parameters such as creatinine, total protein and albumin showed significant, progressive decreases in mean values starting 5 years prior to diagnosis (p < 0.0001). Patients with CD had distinct laboratory trends when compared with patients with UC.
Changes in laboratory parameters, healthcare service and medication use occur during the 5-year period before IBD diagnosis. These data can have future clinical applicability by developing a composite score and referral algorithm introducing red flags into primary care visits and appropriate referral for specialist care.
描述炎症性肠病（IBD）患者诊断前变化的数据很少。我们旨在确定在诊断前几年中，卫生资源使用、药物治疗和实验室检查结果是否存在变化模式。
这项回顾性研究使用了马卡比医疗服务公司（MHS）的电子病历。通过纳入MHS的IBD登记系统，确定年龄≥16岁且至少有5年随访记录的IBD患者，并纳入分析。收集了人口统计学、临床、药物治疗和实验室数据。应用广义估计方程模型研究趋势并比较各年份之间的差异。
本研究纳入了5643例IBD患者。其中，3039例（53.8%）患有克罗恩病（CD），2322例（41.1%）患有溃疡性结肠炎（UC），282例（5%）患有不确定性结肠炎（IC）。包括白细胞、血小板和C反应蛋白在内的实验室参数在诊断前2年平均值显著升高，而血红蛋白和平均红细胞体积在此之前平均值显著下降（p<0.0001）。肌酐、总蛋白和白蛋白等参数在诊断前5年开始平均值显著逐步下降（p<0.0001）。与UC患者相比，CD患者有明显不同的实验室检查趋势。
在IBD诊断前的5年期间，实验室参数、医疗服务和药物使用发生了变化。通过制定综合评分和转诊算法，在初级保健就诊时引入警示信号并适当转诊至专科护理，这些数据在未来可能具有临床适用性。
