Crohn’s disease-specific mortality: a 30-year cohort study at a tertiary referral center in Japan

Shigeyoshi Yasukawa, Toshiyuki Matsui, Yutaka Yano, Yuho Sato, Yasumichi Takada, Masahiro Kishi, Yoichiro Ono, Noritaka Takatsu, Takashi Nagahama, Takashi Hisabe, Fumihito Hirai, Kenshi Yao, Toshiharu Ueki, Daijiro Higashi, Kitaro Futami, Suketo Sou, Toshihiro Sakurai, Tsuneyoshi Yao, Hiroshi Tanabe, Akinori Iwashita, Masakazu Washio

In this study, survival and cause of death were investigated in patients with Crohn's disease (CD) at a tertiary referral center. A database was created based on the medical records of 1108 CD patients who had a history of visiting our hospital to investigate background characteristics, cumulative survival rates from diagnosis, causes of death, and the standardized mortality ratio (SMR) for each cause of death. A follow-up questionnaire survey of patients followed up inadequately was also conducted. The cumulative survival rate from diagnosis was determined using the life table method and compared with that of a sex- and age-matched population model from the year 2000. The study included 1108 patients whose mean age at diagnosis was 25.6 ± 10.8 years. The mean duration of follow-up was 14.6 ± 9.4 years, and there were 52 deaths. The cumulative survival rate was significantly lower 25 years after the diagnosis of CD (91.7%) than in the standard population model (95.7%). SMRs for both all causes [3.5; 95% confidence interval (CI): 2.7-4.6] and CD-specific causes (36.7; 95% CI 26.1-51.6) were high. Among the CD-specific causes, SMRs were especially high for small intestine and colorectal cancers, gastrointestinal diseases including intestinal failure (IF), perioperative complications, and amyloidosis. The SMRs for both all causes and CD-specific causes were high in CD patients. CD-specific causes including intestinal cancer, IF, perioperative complications, and amyloidosis showed especially high SMRs.