Digestive diseases and sciences · 2016
Diagnostic Delay Is Associated with a Greater Risk of Early Surgery in a French Cohort of Crohn's Disease Patients.
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Nahon Stéphane, Lahmek Pierre, Paupard Thierry, Lesgourgues Bruno, Chaussade Stanislas, Peyrin-Biroulet Laurent, Abitbol Vered
Аннотация
AIM: To investigate whether a diagnostic delay is associated with a poor outcome in Crohn's disease (CD).
METHODS: Medical and socioeconomic characteristics as well as medications and need for surgery of consecutive CD adults patients followed in three referral centers were prospectively recorded using an electronic database (Focus_MICI®). A long diagnostic delay was defined by the upper quartile. We compared patients with long diagnostic delay to those with earlier diagnosis regarding the time to: (1) first intestinal surgery, (2) first use of immunosuppressants (IMSs), and (3) first use of anti-tumor necrosis factor (anti-TNF) therapy using the Kaplan-Meier test and the log-rank test.
RESULTS: A total of 497 patients with CD (53.6 % women) were analyzed. Median diagnostic delay was 5 months (IQR 25-75 %: 2-13 months). Median follow-up was 9 years (IQR 4-16.2), and 148 (29.8 %) patients had major surgery. There were no significant differences between patients with late and early diagnosis regarding age at diagnosis, disease phenotype, need for IMS therapy, and need for anti-TNF therapy. Time to first major surgery was shorter in patients with late diagnosis (p = 0.05).
CONCLUSION: In this large multicenter prospective cohort of French CD patients, a long diagnostic delay (>13 months) increased the risk of early surgery. No associated factors could be identified in this study.
METHODS: Medical and socioeconomic characteristics as well as medications and need for surgery of consecutive CD adults patients followed in three referral centers were prospectively recorded using an electronic database (Focus_MICI®). A long diagnostic delay was defined by the upper quartile. We compared patients with long diagnostic delay to those with earlier diagnosis regarding the time to: (1) first intestinal surgery, (2) first use of immunosuppressants (IMSs), and (3) first use of anti-tumor necrosis factor (anti-TNF) therapy using the Kaplan-Meier test and the log-rank test.
RESULTS: A total of 497 patients with CD (53.6 % women) were analyzed. Median diagnostic delay was 5 months (IQR 25-75 %: 2-13 months). Median follow-up was 9 years (IQR 4-16.2), and 148 (29.8 %) patients had major surgery. There were no significant differences between patients with late and early diagnosis regarding age at diagnosis, disease phenotype, need for IMS therapy, and need for anti-TNF therapy. Time to first major surgery was shorter in patients with late diagnosis (p = 0.05).
CONCLUSION: In this large multicenter prospective cohort of French CD patients, a long diagnostic delay (>13 months) increased the risk of early surgery. No associated factors could be identified in this study.
Предметные рубрики MeSH
AdalimumabAdultCohort StudiesColectomyConstriction, PathologicCrohn DiseaseDelayed DiagnosisDigestive System Surgical ProceduresEnterostomyFemaleFranceHumansImmunosuppressive AgentsInfliximabIntestinal ObstructionJejunumKaplan-Meier EstimateMaleMethotrexateProspective StudiesRiskTime FactorsTumor Necrosis Factor-alphaYoung Adult