Am J Gastroenterol. 2023 Sep 15. doi: 10.14309/ajg.0000000000002498. Online ahead of print.
BACKGROUND AND AIMS: The American Gastroenterological Association (AGA) has compiled risk factors that may be predictive of disease complications in Crohn’s disease (CD) and ulcerative colitis (UC). The aim of this study was to evaluate the performance of the AGA risk factors for risk stratification in UC and CD.
METHODS: We included participants of two cohorts: OSCCAR and the Mayo Clinic cohort. Baseline clinical risk factors were extracted according to the AGA pathway. Our primary endpoint was defined as inflammatory bowel disease-related: 1) hospitalization, 2) bowel surgery, or 3) progression of disease. We analyzed the association of the number of AGA risk factors with our endpoint. Statistical multivariable modeling was performed with cox proportional hazards model.
RESULTS: A total of 412 CD patients were included. Comparing ≥3 with 0-1 risk factors, we found a significantly increased risk of complications in both OSCCAR (HR 2.75, 95% CI 1.71,4.41) and Mayo cohorts (HR 2.07, 95% CI 1.11,3.84). Diagnosis at younger age (HR 2.07), perianal disease (HR 1.99), and B2/B3 behavior (HR 1.92) were significantly associated with disease complications. We did not observe a consistent association between number of risk factors nor any specific individual risk factors and risk of disease complications in the 265 UC patients included.
CONCLUSIONS: We found a significant association between the number of AGA risk factors and the risk of disease complication in CD; this association was not significant in UC. The presence of ≥ 3 risk factors in CD leads to the highest risk of complications. The AGA care pathway is a useful tool to stratify patients who are at higher risk of disease complications in CD patients.