Prognostic Value of C-Reactive Protein for Intestinal Resection in Crohn’s Disease Patients with Clostridioides difficile Infection: A Single-Center Retrospective Cohort Study
Abstract
Purpose Clostridioides difficile infection (CDI) is one of the most common opportunistic infections in Crohn’s disease (CD). This study aimed to evaluate the prognostic value of C-reactive protein (CRP) for intestinal resection in CD patients with concomitant CDI. Patients and Methods In this single-center retrospective cohort study, 215 patients with CD and CDI were included. Serum CRP was measured on the day of CDI diagnosis. The primary and secondary outcomes were intestinal resection within three months and within one year, respectively. Univariable and multivariable Firth penalized logistic regression were conducted to assess the association between CRP and outcomes, with discriminatory performance evaluated by area under the receiver operating characteristic curve (AUC). Results Overall, 23 patients (10.7%) underwent intestinal resection within three months and 30 (14.0%) within one year. In multivariable analysis, higher CRP was associated with greater odds of intestinal resection within three months (per 1 mg/L, adjusted odds ratio (aOR) [95% CI]: 1.04 [1.02–1.06], p < 0.001) and within one year (per 1 mg/L, aOR [95% CI]: 1.04 [1.02–1.06], p < 0.001). Patients with CRP ≥12 mg/L had higher odds of intestinal resection within three months (aOR [95% CI]: 5.84 [1.89–23.70], p = 0.001). The multivariable model showed an AUC of 0.92 (95% CI 0.88–0.96) for three-month and 0.92 (95% CI 0.89–0.96) for one-year resection. In Cox regression, CRP remained associated with time to intestinal resection (per 1 mg/L, adjusted hazard ratio [95% CI] 1.03 [1.01–1.04], p < 0.001). No significant interaction was observed between CRP and age, sex, biologic exposure, or previous intestinal resection (all p for interaction > 0.05). Although a significant interaction with disease location was observed, the small size of the isolated colonic CD subgroup warrants cautious interpretation of this finding. Conclusion Elevated CRP was associated with an increased risk of subsequent intestinal resection in CD patients with CDI and may have potential prognostic value. Given the single-center retrospective design, these findings require prospective external validation.