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The Risk of Developing Disabling Crohn's Disease: Validation of a Clinical Prediction Rule to Improve Treatment Decision Making

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Bastida Paz G.
  • Merino Ochoa O.
  • Aguas Peris M.
  • Barreiro-De Acosta M.
  • Zabana Y.
  • Ginard Vicens D.
  • Ceballos Santos D.
  • Muñoz Núñez F.
  • Monfort I Miquel D.
  • Catalán-Serra I.
  • García Sánchez V.
  • Loras Alastruey C.
  • Lucendo Villarín A.
  • Huguet J.M.
  • De La Coba Ortiz C.
  • Aldeguer Manté X.
  • Palau Canós A.
  • Domènech Morral E.

Grupos

Abstract

Background: Crohn's disease (CD) is characterized by the development of complications over the course of the disease. It is crucial to identify predictive factors of disabling disease, in order to target patients for early intervention. We evaluated risk factors of disabling CD and developed a prognostic model. Methods: In total, 511 CD patients were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to identify demographic, clinical, and biological risk factors. A predictive nomogram model was developed in a subgroup of patients with noncomplicated CD (inflammatory pattern and no perianal disease). Results: The rate of disabling CD within 5 years after diagnosis was 74.6%. Disabling disease was associated with gender, location of disease, requirement of steroids for the first flare, and perianal lesions. In the subgroup of patients (310) with noncomplicated CD, the rate of disabling CD was 80%. In the multivariate analysis age at onset <40 years (OR = 3.46, 95% confidence interval [CI] = 1.52-7.90), extensive disease (L3/L4) (OR = 2.67, 95% CI = 1.18-6.06), smoking habit (OR = 2.09, 95% CI = 1.03-4.27), requirement of steroids at the first flare (OR = 2.20, 95% CI = 1.09-4.45), and albumin (OR = 0.59, 95% CI = 0.36-0.96) were associated with development of disabling disease. The developed predictive nomogram based on these factors presented good discrimination, with an area under the receiver operating characteristic curve of 0.723 (95% CI: 0.670-0.830). Conclusion: We identified predictive factors of disabling CD and developed an easy-to-use prognostic model that may be used in clinical practice to help identify patients at high risk and address treatment effectively. © 2023 S. Karger AG. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
0257-2753, 1421-9875

DIGESTIVE DISEASES  KARGER

Tipo:
Article
Páginas:
879-889
PubMed:
37611561
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
0,621 SCImago ℠
Cuartil:
Q2 SCImago ℠

Citas Recibidas en Web of Science: 7

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Keywords

  • Adult; Clinical Decision Rules; Crohn Disease; Decision Making; Humans; Retrospective Studies; Risk Factors; Steroids; albumin; azathioprine; C reactive protein; hemoglobin; mercaptopurine; methotrexate; steroid; steroid; abscess; aged; appendectomy; Article; child; clinical decision rule; clinical practice; controlled study; Crohn disease; decision making; diagnostic test accuracy study; explanatory variable; female; fever; fistula; follow up; hospitalization; human; immunosuppressive treatment; inflammatory bowel disease; intestine tumor; major clinical study; male; multicenter study; nomogram; probability; prognosis; receiver operating characteristic; retrospective study; risk; risk factor; smoking; ulcerative colitis; adult; clinical decision rule; complication; Crohn disease; decision making

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