Study on the differences in clinical outcomes of L4 subtypes in patients with Crohn's disease
Objective To investigate whether there are differences in disease outcomes among patients with Crohn's disease(CD)L4 subtype.Methods A total of 488 CD patients who were initially diagnosed at the Quzhou People's Hospital and the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from January 2017 to December 2019 were collected.They were divided into L4a,L4b,and non-L4 groups based on disease site classification,and the differences in intestinal complications and first abdominal surgery rates among the three groups were compared.Results Among the 488 CD patients included in the study,196(40.2％)were classified as L4 type,with L4b type being the predominant type(28.3％,138/488).By confirming the time-dependent receiver operating characteristic(ROC)curve,the disease site can predict the surgical rate during follow-up of CD patients.Compared with non-L4 patients,L4b patients had a higher follow-up surgery rate[59.4％(76/128)vs 27.4％(80/292),P＜0.001],while L4a patients had a lower rate[10.3％(6/58)vs 27.4％(80/292),P=0.009 6].At the same time,the recurrence rate of intestinal obstruction in L4b patients during follow-up was significantly higher than that in L4a and non-L4 patients[46.9％(60/128)vs 6.9％(4/58),P＜0.001;46.9％(60/128)vs 11.6％(34/292),P=0.007].The use of biologics can reduce the surgery rate in L4b patients(HR:1.93,95％CI:1.03-3.63,P=0.040 6).Conclusions The incidence rate of L4b is high in newly diagnosed CD patients,and L4b is a high risk factor for poor prognosis of CD,so early use of biological agents is recommended.Accurate classification of disease sites can guide individualized clinical treatment.
Crohn's diseaseDisease site classificationTreatment outcome
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NSTL
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