C-Reactive Protein as a Predictor of Colectomy in Ulcerative Colitis Flares: A Retrospective Cohort Study at the University of Nigeria Teaching Hospital

Abstract

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease that often requires surgical intervention, such as colectomy, in severe cases. C-reactive protein (CRP) is an established marker of inflammation, and its role as a predictor of colectomy in patients with UC flare remains a subject of ongoing research. This study aimed to evaluate the predictive value of CRP levels in determining the likelihood of colectomy in UC patients presenting with a flare at the University of Nigeria Teaching Hospital. Methods: A retrospective cohort study was conducted involving patients admitted with a UC flare between January 2015 and December 2023. Data on demographics, CRP levels, treatment modalities, and colectomy outcomes were extracted from medical records. CRP levels were categorised into three groups: <10 mg/L, 10-50 mg/L, and >50 mg/L. The primary outcome was the need for colectomy during the hospitalisation. Results: A total of 210 patients met the inclusion criteria. The mean age was 42.5 years, with 52.4% being male. The median CRP level at admission was 34.6 mg/L (IQR: 15.2-68.9 mg/L). Colectomy was performed in 27% (n=57) of the patients. Patients with CRP levels >50 mg/L had a significantly higher risk of undergoing colectomy compared to those with CRP levels <10 mg/L (OR: 4.32, 95% CI: 2.15-8.68, p<0.001). Multivariate analysis, adjusting for age, gender, disease duration, and steroid use, confirmed that elevated CRP levels (>50 mg/L) were an independent predictor of colectomy (adjusted OR: 3.85, 95% CI: 1.89-7.84, p<0.001). Conclusion: CRP levels at admission serve as a significant predictor of colectomy in patients with UC flare, with levels >50 mg/L being particularly indicative of the need for surgical intervention. These findings suggest that CRP could be used as a clinical tool to stratify UC patients by risk of requiring colectomy, thereby guiding more tailored treatment strategies.