New risk score helps predict intra-abdominal abscess in Crohn's disease

By Reuters Staff

NEW YORK (Reuters Health) - 5/3/2019

A new, five-parameter risk score accurately predicts intra-abdominal abscess in Crohn's disease (CD) patients presenting to the emergency department (ED), researchers from Israel report.

As many as 28% of patients with Crohn's disease develop fistulas, increasing the risk of an intra-abdominal abscess, Dr. Eran Israeli from Hebrew University Medical Center in Jerusalem and colleagues note in the Journal of Crohn's and Colitis, online February 14. How to identify such abscesses without exposing patients to unnecessary CT scans remains unclear.

Dr. Israeli and colleagues sought to develop a simple, noninvasive scoring system for separating patients presenting to the ED into high- and low-risk of an intra-abdominal abscess in their retrospective, case-control study.

They identified five variables to which they assigned points that would be summed for their risk prediction score: ileo-colonic location of Crohn's disease (one point); perianal disease (three points); absence of current corticosteroids (two points); neutrophil to lymphocyte ratio (NLR) >11.75 (three points); and C-reactive protein (CRP) >0.5 mg/dL (five points).

A score greater than nine correctly identified 38 of 72 patients (53%) with an intra-abdominal abscess, but incorrectly staged 20 of 58 patients (35%) with high scores, for a positive predictive value of 65%.]

A score of seven or less correctly identified 62.4% of patients without an intra-abdominal abscess, but incorrectly staged 11 of the 157 patients (7%) with low scores, for a negative predictive value of 93%.

"We recommend incorporating the score into clinical decision making regarding the need for ordering an immediate abdominal CT for these patients given that this population is significantly more exposed to ionizing radiation," the researchers conclude. "Additional prospective studies should be performed to validate our findings."

Dr. Israeli did not respond to a request for comments.


J Crohns Colitis 2019.

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