Objective To predict relapse in patients with Crohn's disease in clinical remission. Design A total of 107 consecutive outpatients in clinical remission for at least 1 month were followed up without treatment for 18 months or until clinical relapse. Methods Blood tests, Crohn's Disease Activity Index and a series of clinical characteristics were measured on entry into the study. Results Using the blood tests performed on entry into the study, we were able to develop a simplified prognostic index (New Index) predictive of relapse within 18 months if alpha-1-glycoprotein was >130 mg/dl, alpha-2-globulins > 9.0 gm/l or erythrocyte sedimentation rate > 40mm/hr. Clinical characteristics were then used to identify two groups with different risks of relapse. The favourable group included all patients with more than 24 months since last relapse and operated patients with no subsequent relapse (relapse rate 19%). The unfavourable group included all other patients (relapse rate 65%). The New Index was predictive of relapse in the whole sample and in each of the risk groups. Blood tests and clinical characteristics are complimentary predictors of risk. Conclusions The suggested algorithm, using blood tests and clinical characteristics is simple and could be used to monitor patients with Crohn's disease in clinical remission and to balance groups in multicentre trials.
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Brignola et al. (1994) studied this question.