Prognostic significance of severe preoperative lymphopenia in patients with Crohn's disease

Nearly 30% of patients with Crohn's disease requiring operative treatment have severe peripheral lymphopenia. The surgical significance of this finding had not been previously determined. One hundred fifty-eight patients with Crohn's disease admitted for resection of the diseased bowel were studied. Forty-six had preoperative peripheral lymphocyte counts under 1000 cells per mm³. Severely lymphopenic patients had a significantly higher incidence of skip areas and epithelioid granulomas than patients with higher lymphocyte counts. Also, lymphopenic patients were more likely to require separate resections of the diseased bowel and more than one anastomosis. Postoperative follow-up revealed that patients with preoperative lymphopenia had a markedly higher incidence of symptomatic recurrences within 3 years of operation (67 vs. 36%, p < 0.01). It appears that the preoperative peripheral lymphocyte count may be used as an indicator of disease severity and prognosis in patients with Crohn's disease.