Crohn hastalarında cerrahi gereksinimini öngören klinik faktörlerin değerlendirilmesi: Tek merkez deneyimi

Öz

Giriş ve Amaç: Crohn hastalığında cerrahi gereksinimi, hastalık prognozunu ve yaşam kalitesini önemli ölçüde etkileyen temel klinik sonlanımlardan biridir. Cerrahi gereksinimini öngören risk faktörlerinin belirlenmesi, yüksek riskli hastaların erken tanınmasına ve uygun tedavi stratejilerinin geliştirilmesine katkı sağlayabilir. Bu çalışmada, Crohn hastalarında majör cerrahi gereksinimi ile ilişkili klinik, demografik ve laboratuvar faktörlerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Hacettepe Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı’nda takip edilen Crohn hastalarının verileri retrospektif olarak incelendi. Demografik özellikler, Montreal sınıflaması, vücut kitle indeksi, C-reaktif protein, hemoglobin, albümin, Crohn Hastalığı Aktivite İndeksi, Crohn Hastalığı için Basitleştirilmiş Endoskopik Skorlama Sistemi skorları değerlendirildi. Cerrahi öyküsü olan ve olmayan hastalar karşılaştırıldı. Anlamlı bulunan değişkenler çok değişkenli lojistik regresyon analizi ile incelendi. Bulgular: Toplam 86 hastanın 14’ünde (%16,3) cerrahi öyküsü mevcuttu. Cerrahi uygulanan hastalarda; vücut kitle indeksi, albümin ve hemoglobin düzeyleri anlamlı olarak daha düşük, C-reaktif protein düzeyi ise daha yüksekti (p < 0,05). Kategorik analizde vücut kitle indeksi ≤ 18,5 kg/m², albümin < 3,5 g/dL, anemi ve C-reaktif protein > 5 mg/L cerrahi öyküsü ile ilişkili bulundu. Çok değişkenli analizde yalnızca vücut kitle indeksi ≤ 18,5 kg/m² bağımsız risk faktörü olarak saptandı (Odds oranı = 13,659; %95 Güven aralığı: 1,135 - 164,434; p = 0,039). Sonuç: Düşük vücut kitle indeksi, Crohn hastalarında majör cerrahi gereksinimi ile ilişkili görünmektedir. Hipoalbüminemi, anemi ve yüksek C-reaktif protein cerrahi gereksinimi ile ilişkili olmakla birlikte bağımsız belirleyiciler değildi. Bulguların daha geniş, prospektif çalışmalarla doğrulanması gerekmektedir.

Anahtar Kelimeler

• Crohn hastalığı
• cerrahi gereksinimi
• vücut kitle indeksi
• risk faktörleri

Evaluation of clinical factors predicting the need for surgery in patients with Crohn’s disease: Single center experience

Öz

Background and Aims: The need for surgery in Crohn's disease is one of the key clinical outcomes that significantly affects disease prognosis and quality of life. Identifying risk factors predicting the need for surgery can contribute to the early identification of high-risk patients and the development of appropriate treatment strategies. This study aimed to evaluate the clinical, demographic, and laboratory factors associated with the need for major surgery in Crohn's disease patients. Materials and Methods: Data from Crohn's disease patients followed up at the Department of Gastroenterology, Hacettepe University Faculty of Medicine were retrospectively reviewed. Demographic characteristics, Montreal classification, body mass index, C-reactive protein, hemoglobin, albumin, Crohn Disease Activity Index and Simple Endoscopic Score for Crohn Disease scores were evaluated. Patients with and without a history of surgery were compared. Variables found to be significant were examined using multivariate logistic regression analysis. Results: Of the total 86 patients, 14 (16.3%) had a history of surgery. In patients who underwent surgery, body mass index, albumin, and hemoglobin levels were significantly lower, while C-reactive protein levels were higher (p < 0.05). In categorical analysis, body mass index ≤ 18.5 kg/m², albumin < 3.5 g/dL, anemia, and C-reactive protein > 5 mg/L were associated with a history of surgery. In multivariate analysis, only body mass index ≤ 18.5 kg/m² was identified as an independent risk factor (Odds Ratio = 13.659; 95% Confidence Interval: 1.135 - 164.434; p = 0.039). Conclusion: Low body mass index was identified as an independent risk factor for the need for major surgery in Crohn's disease patients. Hypoalbuminemia, anemia, and high C-reactive protein were associated with surgery but were not independent predictors. These findings need to be confirmed by larger, prospective studies.

Anahtar Kelimeler

• Crohn's disease
• need for surgery
• body mass index
• risk factors

Kaynakça

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