Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2015; 21(23): 7272-7280
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7272
Prevalence and predictors of hospitalization in Crohn’s disease in a prospective population-based inception cohort from 2000-2012
Petra A Golovics, Laszlo Lakatos, Michael D Mandel, Barbara D Lovasz, Zsuzsanna Vegh, Zsuzsanna Kurti, Istvan Szita, Lajos S Kiss, Tunde Pandur, Peter L Lakatos
Petra A Golovics, Michael D Mandel, Barbara D Lovasz, Zsuzsanna Vegh, Zsuzsanna Kurti, Lajos S Kiss, Peter L Lakatos, First Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary
Laszlo Lakatos, Zsuzsanna Vegh, Istvan Szita, Tunde Pandur, Department of Medicine, Csolnoky Ferenc Province Hospital, H-8200 Veszprem, Hungary
Author contributions: Golovics PA and Lakatos L study design, data collection, supervising the collection and validation of patients, database construction, and manuscript preparation; Szita I and Pandur T data collection and manuscript preparation; Mandel MD, Lovasz BD, Vegh Z, Kurti Z and Kiss LS database construction, data validation, data analysis and manuscript preparation; Lakatos PL study design, data collection, supervising the collection and validation of patients, database construction, statistical analysis, and manuscript preparation; all authors have approved the final draft submitted.
Ethics approval: The study protocol was approved by Semmelweis University Regional and Institutional Committee of Science and Research Ethics and the Regional and Institutional Committee of Science and Research Ethics Veszprem.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter L Lakatos, MD, PhD, First Department of Medicine, Semmelweis University, Koranyi S. 2/A, H-1083 Hungary. lakatos.peter_laszlo@med.semmelweis-univ.hu
Telephone: +36-1-2100278 Fax: +36-1-3130250
Received: January 5, 2015
Peer-review started: January 6, 2015
First decision: March 10, 2015
Revised: March 24, 2015
Accepted: May 4, 2015
Article in press: May 4, 2015
Published online: June 21, 2015
Processing time: 165 Days and 20.4 Hours
Abstract

AIM: To analyze the prevalence, length and predictors of hospitalization in the biological era in the population-based inception cohort from Veszprem province.

METHODS: Data of 331 incident Crohn’s disease (CD) patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (median age at diagnosis: 28; IQR: 21-40 years). Both in- and outpatient records were collected and comprehensively reviewed.

RESULTS: Probabilities of first CD-related hospitalization and re-hospitalization were 32.3%, 45.5%, 53.7% and 13.6%, 23.9%, 29.8%, respectively after one, three and five years of follow-up in Kaplan-Meier analysis. First-year hospitalizations were related to diagnostic procedures (37%), surgery or disease activity (27% and 21%). Non-inflammatory disease behavior at diagnosis (HR = 1.32, P = 0.001) and perianal disease (HR = 1.47, P = 0.04) were associated with time to first CD-related hospitalization, while disease behavior change (HR = 2.38, P = 0.002) and need for steroids (HR = 3.14, P = 0.003) were associated with time to first re-hospitalization in multivariate analyses. Early CD-related hospitalization (within the year of diagnosis) was independently associated with need for immunosuppressives (OR = 2.08, P = 0.001) and need for surgeries (OR = 7.25, P < 0.001) during the disease course.

CONCLUSION: Hospitalization and re-hospitalization rates are still high in this cohort, especially during the first-year after the diagnosis. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factor of both hospitalization and re-hospitalization.

Keywords: Crohn’s disease; Hospitalization; Recurrence; Predictor; Population-based; Biological therapy

Core tip: Recent data on hospitalization rates in Crohn’s disease (CD) are lacking from population-based studies. In the present study our aim was to analyze the prevalence, cause and predictors of hospitalization and re-hospitalization in the population-based inception cohort from Veszprem province. Relatively high rates of CD-related hospitalizations and re-hospitalizations were found in our cohort, especially during the first year after the diagnosis. Non-inflammatory disease behavior at diagnosis, behavior change in patients with initial B1 behavior, perianal disease and total AZA and anti-TNF exposure was associated with the time to first CD-related hospitalization. Early CD-related hospitalization was associated with non-inflammatory disease behavior, perianal or internal fistulizing disease, need for immunosuppressives and need for surgeries during the disease course.