Risk factors and prognostic value of acute severe lower gastrointestinal bleeding in Crohn’s disease

Table 1 Demographic and clinical characteristics of patients with Crohn’s disease according to the presence of acute severe lower gastrointestinal bleeding

	Bleeding group (n = 75)	Non-bleeding group (n = 1359)	P value
Age at diagnosis, years (median, IQR)	23.6 (18.9-31.9)	23.2 (18.6-33.5)	0.952
Sex, male, n (%)	63 (84.0)	1000 (73.6)	0.045
Disease location at diagnosis, n (%)			0.002
Ileum	34 (45.3)	377 (27.7)
Colon	1 (1.3)	81 (6.0)
Ileocolon	40 (53.4)	901 (66.3)
Upper GI modifier at diagnosis, n (%)	15 (20)	355 (26.1)	0.238
Disease behavior at diagnosis, n (%)			0.157
Non-stricturing, non-penetrating	59 (78.6)	1012 (74.5)
Stricturing	11 (14.7)	155 (11.4)
Penetrating	5 (6.7)	192 (14.1)
Perianal modifier at diagnosis, n (%)	32 (42.7)	686 (50.5)	0.204
Smoking status at diagnosis, n (%)			0.540
Never smokers	51 (68.0)	874 (64.3)
Ex-smokers	3 (4.0)	99 (7.3)
Current smokers	21 (28.0)	386 (28.4)
Early use of medications, n (%)
Corticosteroids	21 (28.0)	399 (29.4)	0.840
Thiopurines	10 (13.3)	649 (47.8)	< 0.001
Anti-TNF agents	1 (1.3)	43 (3.2)	0.560

IQR: Interquartile range; GI: Gastrointestinal; TNF: Tumor necrosis factor.

Table 2 Risk factors of acute severe lower gastrointestinal bleeding in patients with Crohn’s disease

	Univariate analysis		Multivariable analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Age at diagnosis	1.01 (0.98-1.03)	0.663
Sex
Male	Reference		Reference
Female	0.51 (0.28-0.95)	0.035	0.51 (0.27-0.94)	0.031
Disease location at diagnosis
Colon	Reference		Reference
Ileum	7.56 (1.04-55.26)	0.046	6.58 (0.90-48.12)	0.063
Ileocolon	3.60 (0.50-26.22)	0.206	3.86 (0.53-28.09)	0.182
Upper GI modifier at diagnosis
No	Reference
Yes	0.78 (0.45-1.38)	0.401
Disease behavior at diagnosis
Non-stricturing, non-penetrating	Reference
Stricturing	1.10 (0.58-2.10)	0.763
Penetrating	0.45 (0.18-1.13)	0.067
Perianal modifier at diagnosis
No	Reference		Reference
Yes	0.71 (0.45-1.12)	0.142	0.74 (0.42-1.19)	0.209
Smoking status at diagnosis
Never smokers	Reference
Ex-smokers	0.59 (0.18-1.88)	0.368
Current smokers	0.93 (0.56-1.55)	0.783
Early use of medications
Corticosteroids	0.94 (0.57-1.58)	0.840
Thiopurines	0.17 (0.09-0.34)	0.001	0.23 (0.12-0.48)	< 0.001
Anti-TNF agents	0.41 (0.12-3.21)	0.560

HR: Hazard ratio; CI: Confidence interval; GI: Gastrointestinal; TNF: Tumor necrosis factor.

Table 3 Comparison of the baseline parameters between patients with acute severe lower gastrointestinal bleeding and matched patients without

	Before matching			After matching
	Bleeding group (n = 75)	Non-bleeding group (n = 1359)	SMD	Bleeding group (n = 72)	Non-bleeding group (n = 267)	SMD
Age at diagnosis, years (median, IQR)	23 (18-32)	23 (18-33)	0.009	22 (18-31.5)	23 (18-30)	0.061
Male, n (%)	63 (84.0)	1000 (73.6)	0.257	63 (87.5)	234 (87.6)	0.004
Disease location at diagnosis, n (%)			0.391			0.020
Ileum	34 (45.3)	377 (27.7)		31 (43.1)	111 (41.6)
Colon	1 (1.3)	81 (6.0)		1 (1.4)	4 (1.5)
Ileocolon	40 (53.3)	901 (66.3)		40 (55.6)	152 (56.9)
Disease behavior at diagnosis, n (%)			0.301			0.030
Non-stricturing, non-penetrating	59 (78.7)	1012 (74.5)		58 (80.6)	219 (82.0)
Stricturing	11 (14.7)	155 (11.4)		9 (12.5)	32 (12.0)
Penetrating	5 (6.7)	192 (14.1)		5 (6.9)	16 (6.0)

SMD: Standardized mean difference; IQR: Interquartile range.

Table 4 Comparison of the outcome parameters between patients with acute severe lower gastrointestinal bleeding and matched patients without during the period before the bleeding/index date

	Bleeding group (n = 72)	Non-bleeding group (n = 267)	Matched OR (95%CI)	P value
Use of medications, n (%)
Corticosteroids	19/72 (26.4)	78/267 (29.2)	0.82 (0.43-1.57)	0.55
Thiopurines	27/72 (37.5)	108/267 (40.4)	0.74 (0.36-1.51)	0.40
Anti-TNF agents	6/72 (8.3)	27/267 (10.1)	0.68 (0.24-1.91)	0.47
Behavioral progression, n (%)	10/58 (17.2)	21/219 (9.6)	1.96 (0.87-4.44)	0.10
Intestinal resection, n (%)	13/72 (18.1)	30/267 (11.2)	1.83 (0.73-4.58)	0.20

OR: Odds ratio; CI: Confidence interval; TNF: Tumor necrosis factor.

Table 5 Comparison of the hospitalization rate between patients with acute severe lower gastrointestinal bleeding and matched patients without

Hospitalization rate (per 100 patient-years)	Bleeding group (n = 72)	Non-bleeding group (n = 267)	Hospitalization rate ratio (95%CI)	P value
Before bleeding/index date (95%CI)	21.0 (14.5-30.5)	23.6 (19.0-29.2)	0.89 (0.58-1.37)	0.599
After bleeding/index date (95%CI)
Excluded: Index hospitalization	22.1 (16.5-29.4)	13.2 (11.2-15.5)	1.67 (1.20-2.33)	0.012
Excluded: Hospitalizations due to bleeding	14.5 (10.3-20.4)	13.2 (11.2-15.5)	1.10 (0.75-1.60)	0.631

CI: Confidence interval.