Sa1202 Serum Ficolin-2 Correlates Worse Than Fecal Calprotectin and CRP With Endoscopic Crohn's Disease Activity

The Development of e-Health Tools for the Management of Inflammatory Bowel Diseases Welmoed K. van Deen, Jennifer M. Choi, Aria Zand, Christina Y. Ha, Elizabeth K. Inserra, Laurin Eimers, Adriana Centeno, Bennett E. Roth, Daniel Cole, Terri Getzug, Ellen Kane, Lynn S. Connolly, Mark Ovsiowitz, Andrew D. Ho, Martijn G. van Oijen, Eric Esrailian, Daniel W. Hommes Introduction The transition from ‘symptom-oriented' to ‘prevention oriented' care as well as the shift from the ‘fee-for-services' to the ‘quality payment' model is accelerating the development of e-health technologies. However, accurate e- monitoring tools have yet to be developed. We 1) evaluated how patient reported outcomes predict disease activity and quality of life (QoL); 2) tested the feasibility of using patient reported outcomes in e-health monitoring; and 3) developed an ‘IBD app' for iOS and Android that allows the integration of patient reported outcomes into electronic health records. Methods Disease activity indices (DAI) were assessed in consecutive IBD patients. To analyze the predictive value of each patient-reported component, logistic regression analyses were performed, using the SCCAI and partial Mayo score for ulcerative colitis (UC), and the CDAI and HBI for Crohn's disease (CD) as gold standards. The added value of the biomarkers CRP and fecal calprotectine was also assessed. To evaluate the feasibility of using e-health for the reporting of health related outcomes, a web based application was developed, which was subsequently developed into an app for iOS and Android allowing the capturing and monitoring of patient reported outcomes. Results We included 107 UC patients and 78 CD patients, of which 31 (29%) and 17 (22%) had active disease respectively. Strong predictors for UC disease activity were urgency (73% with urgency had active disease, 5% without urgency had active disease) and blood in stool (68% with blood in stool had active disease, 3% that did not). Addition of calprotectin increased specificity to 100%, though sensitivity decreased to 67%. In CD, 71% of CD patients with abdominal pain had active disease, versus 4% of those without pain. 93% of CD patients with more than 2 stools per day had active disease, versus 6% with 2 or less. The combination of >2 stools and abdominal pain predicted active disease with 70% sensitivity and 100% specificity. Addition of a biomarker did not increase sensitivity or specificity. The developed web-based application was launched in September 2012 and is effectively utilized by 335 patients. A mobile UCLA IBD app was co-created with patients, tested and approved as of November 24, 2013 (search ‘UCLA eIBD' in iTunes and Google Play stores). Conclusions E-health technologies are predicted to revolutionize care delivery and patient engagement. Patients can participate in their care by signaling meaningful health outcomes during year-round monitoring. We showed that patient reported outcomes can predict disease activity, and can be collected easily through e-health applications. This ehealth platform could set the stage for early detection of disease activity. Sa1204 Correlation of Rutgeerts Score and Postoperative Recurrence of Crohn's Disease in Patients With End Ileostomy Vasutakarn Chongthammakun, Rocio Lopez, Bo Shen Introduction Recurrence of Crohn's disease (CD) highly occurs after surgery. Rutgeerts et al. developed a score used to predict CD recurrence after ileocolonic resection and anastomosis by examination of the neoterminal ileum and anastomotic site with colonoscopy. Higher scores were greatly associated with endoscopic and clinical recurrence. The aim of this study is to evaluate the application of Rutgeerts score to ileal findings on retrograde ileoscopy and its role in predicting recurrence in CD patients after end ileostomy (EI). Methods A retrospective study was conducted in CD patients who had at least 2 ileoscopies at the Cleveland Clinic following colectomy with EI. The severity of ileal findings was graded by degree of inflammation and number of ulcers characterized from grade i,0 to i,4 as characterized by Rutgeerts et al. The study emphasized on postoperative endoscopic findings and its progression over time, as well as clinical correlations. Primary outcomes were defined as the need for endoscopic stricture dilation and subsequent surgery due to complications of disease. Secondary outcomes were determined by disease-related hospitalization and requirement of escalation of CD-associated medications. For each outcome, follow-up time was defined as months from EI to either the event or last available follow-up if no event. Results A total of 73 subjects (29% men, average age at EI 35 years) were included in the analysis. The median duration of disease until EI was 9 months and median duration from EI to first ileoscopy was 28 months. Based on the Rutgeerts score closest to surgery, subjects were divided into 2 groups: 1) Score = 0 and 2) Score 1- 4. Thirty-four percent had Rutgeerts score > 0 on their first ileoscopy. Male gender and higher number of prior surgeries were found to be related to Rutgeerts score > 0. Based on Cox regression analysis, an increment of Rutgeerts score was associated with higher rates of endoscopic dilations, repeat surgeries, and hospital readmissions. After adjusting for time to score determination, subjects with Rutgeerts score > 0 had a hazard ratio of 7.7, 8.4, and 5.2 for need for endoscopic dilation, need for repeat surgery, and readmission as compared to those with score of 0, respectively (p <0.001). In addition, unadjusted analysis showed that subjects with Rutgeerts score > 0 had 5.3 times higher odds of needing escalation of CD-related medications than those with a score of 0 (p=0.002). Conclusions Rutgeerts score can be used to predict recurrence of CD in postoperative patients with EI. Higher scores based on ileoscopic findings are associated with poor outcomes. This may be considered a useful tool for decision making after surgery whether to escalate treatment and routine surveillance ileoscopy within the first 3 years may be favorable.

Item-level correlations and correlations with patient-defined symptom flare and clinician global assessment are reported as Spearman's rho for rank-ordered data. Total score correlations are reported as Pearson's r. α Item from the self-administered Harvey-Bradshaw Disease Activity Index for Crohn's Disease (HBI), α = .60. β Item from the newly-developed Symptoms of IBD Inventory. Symptoms are rated on a 5-point Likert scale assessing level of difficulty experienced, ranging from 0=none, 1=a little, 2=moderate, 3=quite a lot, to 4= severe, α = 91. γ Reported item-total jackknife correlations are with either the HBI or the Symptoms of IBD Inventory total score. ζ p < .05; ε p < .01; δ p < .001 Sa1202 Serum Ficolin-2 Correlates Worse Than Fecal Calprotectin and CRP With Endoscopic Crohn's Disease Activity Alain Schoepfer, Thomas Schaffer, Frank Seibold Background: Ficolin-2 is an acute phase reactant produced by the liver and targeted to recognize N-acetyl-glucosamine which is present in bacterial and fungal cell walls. We recently showed that ficolin-2 serum levels were significantly higher in Crohn's disease (CD) patients compared to healthy controls. Of note, no difference was found regarding serum ficolin-2 levels when comparing patients with ulcerative colitis to healthy controls. Aim: to evaluate serum ficolin-2 concentrations in CD patients regarding their correlation with endoscopic severity and to compare them with clinical activity, fecal calprotectin, and CRP. Methods: Patients provided fecal and blood samples before undergoing ileo-colonoscopy. Disease activity was scored clinically according to the Harvey Bradshaw Index (HBI) and endoscopically according to the simplified endoscopic score for CD (SES-CD). Ficolin-2 serum levels and fecal calprotectin levels were measured by ELISA. Results: A total of 136 CD patients were prospectively included (mean age at inclusion 41.5 ± 15.4 years, 37.5% females). Median HBI was 3 [2-6] points, median SES-CD was 5 [2-8], median fecal calprotectin was 300 [120-703] μg/g, and median serum ficolin-2 was 2.69 [2.02-3.83] μg/mL. The SES-CD score correlated significantly with fecal calprotectin levels (r = 0.639, p < 0.001), CRP (r = 0.444, p < 0.001), and the HBI (r = 0.363, p < 0.001), whereas only a weak correlation was found with ficolin-2 serum levels (r = 0.144, p = 0.094). Ficolin-2 serum levels were higher in CD patients with mild endoscopic disease compared to patients in endoscopic remission (p = 0.021) but no difference in ficolin-2 serum levels was found between patients with mild, moderate, and severe endoscopic disease. Conclusion: Ficolin2 serum levels correlate worse with endoscopic CD activity when compared to fecal calprotectin, CRP or Harvey-Bradshaw index. Ficolin-2 serum levels will probably not have a future role as biomarkers to monitor endoscopic CD activity.

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Sa1203