Intestinal Dilation and Platelet:Albumin Ratio Are Predictors of Surgery in Stricturing Small Bowel Crohn's Disease

Clin Gastroenterol Hepatol. 2016 Aug;14(8):1112-1119.e2. doi: 10.1016/j.cgh.2016.04.033. Epub 2016 May 4.


Background & aims: It is a challenge to predict how patients with small bowel Crohn's disease (CD) will respond to intensified medical therapy. We aimed to identify factors that predicted surgery within 2 years of hospitalization for CD, to guide medical versus surgical management decisions.

Methods: We performed a retrospective review of adults hospitalized for small bowel CD from 2004 through 2012 at a single academic referral center. Subjects underwent abdominal computed tomography or magnetic resonance imaging within 3 weeks of hospitalization. Imaging characteristics of small bowel dilation, bowel wall thickness, and disease activity were assessed by a single, blinded radiologist. Multivariate analysis by Cox proportional hazards regression techniques was used to generate a prediction model of intestinal resection within 2 years.

Results: A total of 221 subjects met selection criteria, with 32.6% undergoing surgery within 2 years of index admission. Bivariate analysis showed high-dose steroid use (>40 mg), ongoing treatment with anti-tumor necrosis factor agents at admission, platelet count, platelet:albumin ratio, small bowel dilation (≥35 mm), and bowel wall thickness to predict surgery (P ≤ .01). Multivariate modeling demonstrated small bowel dilation >35 mm (hazard ratio, 2.92; 95% confidence interval, 1.73-4.94) and a platelet:albumin ratio ≥125 (hazard ratio, 2.13; 95% confidence interval, 1.15-3.95) to predict surgery. Treatment with anti-tumor necrosis factor agents at admission conferred a nonsignificant increased trend for risk of surgery (hazard ratio, 1.61; 95% confidence interval, 0.994-2.65).

Conclusions: Small bowel dilation >35 mm and high platelet:albumin ratios are independent and synergistic risk factors for future surgery in patients with structuring small bowel CD. Platelet:albumin ratios may capture the relationship between acute inflammation and cumulative damage and serve as markers of intestinal disease that cannot be salvaged with medical therapy.

Keywords: Bowel Obstruction; Outcome; Predictive Model; TNF.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Crohn Disease / diagnostic imaging
  • Crohn Disease / pathology*
  • Crohn Disease / therapy*
  • Decision Support Techniques*
  • Dilatation, Pathologic / diagnostic imaging*
  • Female
  • Humans
  • Intestine, Small / diagnostic imaging
  • Intestine, Small / pathology*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Platelet Count*
  • Prognosis
  • Retrospective Studies
  • Serum Albumin / analysis*
  • Serum Albumin, Human
  • Tomography, X-Ray Computed
  • Young Adult


  • ALB protein, human
  • Serum Albumin
  • Serum Albumin, Human