University of Florida Shands Hospital Gainesville, FL
Introduction: Previous studies have shown that smoking increases risk of flare in Crohn’s patients, but has no effect on risk of flare in Ulcerative Colitis (UC) patients. However most studies have utilized extensive subjective measurements such as Crohn’s Disease Activity Index (CDAI) to assess IBD flare. No study has utilized C-Reactive Protein (CRP)/albumin ratio to monitor flare in IBD patients with smoking status.
Methods: Retrospective analysis was performed on a group of adults ( >18 years old) with an ICD-9/10 code diagnosis of Crohn’s or UC disease during their index hospitalization for suspected IBD flare to a tertiary care center between January 1st 2013 to June 1st 2017. Clinical flare was defined as whether or not they were symptomatic at the time of the encounter based on clinical notes. Inflammation status was assessed using CRP /albumin ratio obtained at that time. Smoking status was defined as ever or never smoker.
Results: Out of 1101 IBD patients, 418 patients had a documented smoking status and a calculable CRP/Albumin ratio; 168 (40.2%) were ever smokers and 250 (59.8%) were never smokers. Ever-smoker IBD and Crohn’s patients who had a flare, had statistically significant higher mean CRP/Albumin ratio than those who did not, (p=0.027 and p=0.012, respectively). Never-smoker IBD and Crohn’s patients who had a flare, had statistically significant higher mean CRP/Albumin ratio than those who did not, (p=0.0001 and p=0.0001, respectively). Ever-smoker UC patients who had a flare, had a lower mean CRP/Albumin ratio, than those who did not (p=0.571). Conversely, never-smoker UC patients who had a flare, had a higher mean CRP/Albumin ratio, than those who did not (p=0.300) (Table 1).
Discussion: Our findings are consistent with previous studies that smoking is associated with an increased risk of flare in Crohn’s patients and has no significant effect on risk of flare in UC patients. Similar to Crohn’s patients, we found that smoking was associated with a higher mean CRP/Albumin ratio in all IBD patients. We utilized a new indicator for measuring flare which is CRP/albumin ratio. This ratio can be easily obtained by clinicians to assess clinical flare in IBD patients with smoking status.
