Development and Validation of Risk Matrices for Crohn’s Disease Outcomes in Patients Submitted to Early Therapeutic Interventions

Dias, Cláudia Camila; Rodrigues, Pedro Pereira; Coelho, Rosa; Santos, Paula Moura; Lago, Paula; Caetano, Cidalina; Rodrigues, Ângela; Portela, Francisco; Oliveira, Ana Catarina Lima de; Ministro, Paula; Cancela, Eugénia; Vieira, Ana Isabel; Barosa, Rita; Cotter, José; Carvalho, Pedro Boal; Cremers, Isabelle; Trabulo, Daniel; Caldeira, Paulo; Antunes, Artur; Rosa, Isadora; Moleiro, Joana; Peixe, Paula; Herculano, Rita; Gonçalves, Raquel; Gonçalves, Bruno; Sousa, Helena Tavares de; Contente, Luís; Morna, Henrique; Lopes, Susana; Magro, Fernando

doi:10.1093/ecco-jcc/jjw207

Cited by 2 publications

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“…This cohort presented a disabling rate of 68%, a similar value to that depicted in previous studies of different Portuguese cohorts [ 9 , 13 ]. However, other authors have reported higher disabling rates [ 4 – 6 ].…”

Section: Discussionsupporting

confidence: 87%

“…disabling disease, defined as a composite endpoint characterized by the presence of at least one of the following events: more than one abdominal surgery or two hospital admissions in the follow-up period; steroid dependence or steroid refractoriness; need for switching the first immunosuppression or anti-TNFα; and the appearance of new clinical events after the index episode (stenosis, anal disease or penetrating disease)[ 9 ];…”

Section: Methodsmentioning

confidence: 99%

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The risk of disabling, surgery and reoperation in Crohn’s disease – A decision tree-based approach to prognosis

et al. 2017

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IntroductionCrohn’s disease (CD) is a chronic inflammatory bowel disease known to carry a high risk of disabling and many times requiring surgical interventions. This article describes a decision-tree based approach that defines the CD patients’ risk or undergoing disabling events, surgical interventions and reoperations, based on clinical and demographic variables.Materials and methodsThis multicentric study involved 1547 CD patients retrospectively enrolled and divided into two cohorts: a derivation one (80%) and a validation one (20%). Decision trees were built upon applying the CHAIRT algorithm for the selection of variables.ResultsThree-level decision trees were built for the risk of disabling and reoperation, whereas the risk of surgery was described in a two-level one. A receiver operating characteristic (ROC) analysis was performed, and the area under the curves (AUC) Was higher than 70% for all outcomes. The defined risk cut-off values show usefulness for the assessed outcomes: risk levels above 75% for disabling had an odds test positivity of 4.06 [3.50–4.71], whereas risk levels below 34% and 19% excluded surgery and reoperation with an odds test negativity of 0.15 [0.09–0.25] and 0.50 [0.24–1.01], respectively. Overall, patients with B2 or B3 phenotype had a higher proportion of disabling disease and surgery, while patients with later introduction of pharmacological therapeutic (1 months after initial surgery) had a higher proportion of reoperation.ConclusionsThe decision-tree based approach used in this study, with demographic and clinical variables, has shown to be a valid and useful approach to depict such risks of disabling, surgery and reoperation.

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Section: Discussionsupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

The risk of disabling, surgery and reoperation in Crohn’s disease – A decision tree-based approach to prognosis

et al. 2017

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Are We Ready to Include Prognostic Factors in Inflammatory Bowel Disease Trials?

Lindholm

Siegel

2019

CPD

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Inflammatory bowel disease (IBD) is a chronic inflammatory disease characterized by periodic episodes of flares and remission. Treatment is aimed at healing the bowel, to ultimately decrease hospitalization rates, need for surgeries and overall disability. In more recent years, treatment has transitioned from a reactive approach to a more proactive approach focusing on treating disease earlier and preventing complications. The challenge lies in identifying patients who need more intensive treatment early and trying to determine who will respond to which medications. Biomarkers and clinical activity scoring systems can be used to help guide treatment decisions. However, IBDs are very heterogeneous and the significance of these biomarkers can be difficult to discern on an individual basis. Recently, prognostic tools have been developed to aid in determining a patient’s prognosis as well as their likelihood to respond to different therapies. Despite this progress, clinical trials have not routinely adopted this approach in their study design. Tools for stratification of disease severity and to personalize treatment choices have the potential to improve our studies both by enriching the patient population and further guiding clinical decision making in practice. This review aims to discuss biomarkers, current prognosticating tools, tools that determine response to therapy and how incorporating these into clinical trials will be beneficial.

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Development and Validation of Risk Matrices for Crohn’s Disease Outcomes in Patients Submitted to Early Therapeutic Interventions

Cited by 2 publications

References 0 publications

The risk of disabling, surgery and reoperation in Crohn’s disease – A decision tree-based approach to prognosis

The risk of disabling, surgery and reoperation in Crohn’s disease – A decision tree-based approach to prognosis

Are We Ready to Include Prognostic Factors in Inflammatory Bowel Disease Trials?

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