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Compare risk factors associated with postoperative infectious complication in Crohn’s disease with and without preoperative infliximab therapy: a cohort study

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Abstract

Purposes

The incidence of postoperative complication is higher in Crohn’s disease (CD) compared with other intestinal disease. There is less published data yet on the comparison of risk factors to predict postoperative complications in CD exposed and unexposed to previous infliximab therapy. Also the relationship between infliximab and postoperative infectious complications is still controversial. Our aim is to compare the risk factors to predict infectious complications in CD with and without preoperative infliximab and to clarify relationship between infliximab and infectious complications.

Methods

This retrospective study included 390 patients from June 2014 to June 2018. Postoperative complications were compared in patients with and without preoperative infliximab. Univariate and multivariable analyses were performed to identify risk factors.

Results

Eighty-five patients received infliximab within 8 weeks of surgery. A total of 129 patients had postoperative complications, with 35 receiving infliximab. No significant differences of whole postoperative complications were found in CD with and without infliximab (p = 0.073). However, patients receiving infliximab suffered more infectious complications (p = 0.010). Preoperative infliximab was confirmed to be an independent risk factor in infectious complications (p = 0.042). Multivariate analysis suggested that increased erythrocyte sedimentation rate (ESR) was an independent risk factor for infectious complications in patients receiving preoperative infliximab (p = 0.022), and increased C-reactive protein was an independent risk factor in patients not receiving preoperative infliximab (p = 0.019).

Conclusions

Preoperative use of infliximab ≤ 8 weeks was independently associated with infectious complications in CD. Risk factors were different in predicting postoperative complications in CD with and without infliximab, and preoperative ESR and C-reactive protein were risk factors, respectively.

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Acknowledgements

The authors gratefully acknowledge all of the investigators for their contributions to the trial.

Funding

This study is supported by grants from the National Natural Science Foundation of China (81800474), the Zhejiang Natural Science Foundation (LY18H030006), and the Zhejiang Province Education Department Foundation (Y201738056).

Author information

Xiaolong Ge and Wei Zhou contributed to the study conception and design; Shasha Tang and Xue Dong contributed to the acquisition of data; Wei Liu, Weilin Qi, Lingna Ye, and Xiaoyan Yang contributed to the analysis and interpretation of data; Shasha Tang and Xue Dong contributed to the drafting of manuscript; Qian Cao, Xaiolong Ge, and Wei Zhou contributed to the critical revision.

Correspondence to Xiaolong Ge or Wei Zhou.

Ethics declarations

The institutional review board of Sir Run Run Shaw Hospital approved the project.

Conflict of interest

The authors declare that they have no conflict of interests.

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Tang, S., Dong, X., Liu, W. et al. Compare risk factors associated with postoperative infectious complication in Crohn’s disease with and without preoperative infliximab therapy: a cohort study. Int J Colorectal Dis (2020). https://doi.org/10.1007/s00384-019-03481-1

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Keywords

  • Infliximab
  • Crohn’s disease
  • Infectious complications
  • Risk factors