P2681 - Validation of AGA Risk Factors for Prediction of IBD Severity

Priscila Santiago, MD¹, Nayantara Coelho-Prabhu, MD¹, Ryan Ungaro, MD, MS², Jessica J. Friton, MA¹, Francis A. Farraye, MD, MSc³, Nader Daoud, MD³, Jaclyn Tuck, MBBCh, MA⁴, Talha Malik, MD, MSPH⁵, Laura Raffals, MD, MS^1
1Mayo Clinic, Rochester, MN; ²Icahn School of Medicine at Mount Sinai, New York, NY; ³Mayo Clinic, Jacksonville, FL; ⁴Mayo School of Graduate Medical Education, Scottsdale, AZ; ⁵Mayo Clinic, Scottsdale, AZ

Introduction: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) with a heterogeneous disease course. The American Gastroenterological Association (AGA) has compiled risk factors that may be predictive of severe disease outcomes. The aim of this study was to validate the AGA risk factors for predicting severity of IBD.

Methods: We included patients that had a baseline data collection within 24 months of the diagnosis of IBD. Clinical features were collected according to the risk factors for aggressive disease from the AGA pathway. Our outcome was defined as a composite of 1) IBD hospitalization, 2) IBD surgery, 3) IBD progression of disease. We analyzed the association of the number of AGA risk factors with our composite outcome. Descriptive statistics was used to analyze the sample and statistical multivariable modeling was performed with cox proportional hazards model.

Results: We identified 172 CD and 117 UC patients that were eligible for data analysis. The median number of risk factors in the CD cohort was 2.0. CD location was described as L1 in 63 (36.8%) patients, L2 in 36 (21.1%), and L3 in 72 (42.1%). 23 (13.4%) patients had a history of bowel resection from IBD at baseline. Within the CD cohort, there was a significant association between the number of risk factors and the risk of an event, with HR 1.28 per risk factor (95% CI 1.01-1.63; p=0.046). Compared to those with 1 or fewer risk factors, having 3-4 risk factors resulted in a risk increase of HR 2.07 (95% CI 1.11-3.84). The median number of risk factors in the UC cohort was 3.0. A total of 94 (80.3%) UC patients had extensive colitis and 92 (78.6%) had a baseline requirement of steroids. Within the UC cohort, there was no significant association between the number of risk factors and the risk of an event, with HR 1.11 per risk factor (95% CI 0.92-1.34; p=0.28). Compared to those with 2 or fewer risk factors, having 5-8 risk factors resulted in a non-significant risk increase of HR 1.45 (95% CI 0.64-3.32).

Discussion: We found a significant association between the number of AGA risk factors and the risk of an adverse event for our Crohn’s cohort; however, this association was not significant in the UC cohort. Specifically, our model showed that the presence of 3-4 risk factors in CD patients leads to the highest risk of severe outcomes. In conclusion, the AGA care pathway is a useful tool to stratify patients who are at higher risk of severe disease, especially in CD patients.




Disclosures:


Priscila Santiago, MD¹, Nayantara Coelho-Prabhu, MD¹, Ryan Ungaro, MD, MS², Jessica J. Friton, MA¹, Francis A. Farraye, MD, MSc³, Nader Daoud, MD³, Jaclyn Tuck, MBBCh, MA⁴, Talha Malik, MD, MSPH⁵, Laura Raffals, MD, MS¹. P2681 - Validation of AGA Risk Factors for Prediction of IBD Severity, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.