Predicting Hospitalization and Outpatient Corticosteroid Use in Inflammatory Bowel Disease Patients Using Machine Learning

Waljee, Akbar K.; Lipson, Rachel; Wiitala, Wyndy L.; Zhang, Yiwei; Liu, Boang; Zhu, Ji; Wallace, Beth; Govani, Shail M.; Stidham, Ryan W.; Hayward, Rodney A.; Higgins, Peter

doi:10.1093/ibd/izx007

Cited by 87 publications

(82 citation statements)

References 28 publications

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“…A neural network that analyzes morphometric images of early-stage biopsies from patients with Crohn's disease identified those with disease progression with approximately 83.3% accuracy and a requirement for surgery with 86.0% accuracy. 99 Waljee et al 100 constructed a ML method to analyze data from electronic medical records that predicted IBD-related hospitalizations and outpatient use of steroids within 6 months with an AUROC curve of 0.87. An ANN predicted the frequency of clinical relapse in patients with IBD with a high level of accuracy.…”

Section: Inflammatory and Other Nonmalignant Lesionsmentioning

confidence: 99%

Application of Artificial Intelligence to Gastroenterology and Hepatology

et al. 2020

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Since 2010, substantial progress has been made in artificial intelligence (AI) and its application to medicine. AI is explored in gastroenterology for endoscopic analysis of lesions, in detection of cancer, and to facilitate the analysis of inflammatory lesions or gastrointestinal bleeding during wireless capsule endoscopy. AI is also tested to assess liver fibrosis and to differentiate patients with pancreatic cancer from those with pancreatitis. AI might also be used to establish prognoses of patients or predict their response to treatments, based on multiple factors. We review the ways in which AI may help physicians make a diagnosis or establish a prognosis and discuss its limitations, knowing that further randomized controlled studies will be required before the approval of AI techniques by the health authorities.

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Section: Inflammatory and Other Nonmalignant Lesionsmentioning

confidence: 99%

Application of Artificial Intelligence to Gastroenterology and Hepatology

et al. 2020

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“…We noticed that some of the non-stricturing CD patients also had high circulating elafin levels, leading to moderate accuracy when elafin alone was used in identifying stricturing CD patients. Elafin alone is not enough to indicate intestinal strictures accurately because the complexity of many clinical characteristics of the patients has not been considered (Isakov, Dotan et al, 2017, Waljee, Lipson et al, 2017.…”

Section: Discussionmentioning

confidence: 99%

High circulating elafin levels are associated with Crohn’s disease-associated intestinal strictures

Wang

Ortiz

Fontenot

et al. 2019

Preprint

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AbstractObjectiveNearly 33% of Crohn’s disease (CD) patients develop intestinal strictures. Antimicrobial peptide or protein expression is associated with disease activity in inflammatory bowel disease (IBD) patients. Circulating blood cells and intestine of IBD patients have abnormal expression of elafin, a human elastase-specific protease inhibitor and antimicrobial peptide. However, the association between elafin and CD-associated intestinal stricture is unknown. We hypothesize the elafin expression in stricturing CD patients is abnormal. We determined the expression of elafin in blood, intestine, and mesenteric fat in IBD patients.MethodsHuman colonic and mesenteric fat tissues and serum samples were collected from the Cedars-Sinai Medical Center and UCLA, respectively.ResultsHigh serum elafin levels were associated with a significantly elevated risk of intestinal stricture in CD patients. Machine learning algorithm using serum elafin levels and clinical data identified stricturing CD patients with high accuracy. Serum elafin levels had weak positive correlation with clinical disease activity (Partial Mayo Score and Harvey Bradshaw Index) in IBD patients. Ulcerative colitis (UC) patients had high serum elafin levels, but the increase was not associated with endoscopic Mayo score. Colonic elafin mRNA and protein expression were not associated with clinical disease activity in IBD patients, while stricturing CD patients had low colonic elafin expression. Mesenteric fat in stricturing CD patients had significantly increased elafin mRNA expression, which may contribute to high circulating elafin level.ConclusionHigh serum elafin levels and adipose elafin expression are associated with intestinal strictures, which may help identify intestinal strictures in CD patients.

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“…Outpatient flares were identified on the basis of filled outpatient prescriptions for corticosteroids using a previously described algorithm. 10 Hospitalizations were inpatient stays associated with an ICD-9-CM code for IBD, and corticosteroids were corticosteroid prescriptions filled during the admission. 10 All of the ICD-9-CM codes and variables used to identify these outcomes, including IBD-related surgical procedures, are presented in eTable 1 in the Supplement .…”

Section: Methodsmentioning

confidence: 99%

“…The primary objective was to examine continuity of care (COC) among veterans with IBD and the association between low levels of COC and selected IBD-related outcomes (ie, outpatient corticosteroid-treated flares, hospitalizations, and surgical interventions). 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

Association of Continuity of Care With Outcomes in US Veterans With Inflammatory Bowel Disease

et al. 2020

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Predicting Hospitalization and Outpatient Corticosteroid Use in Inflammatory Bowel Disease Patients Using Machine Learning

Abstract: A novel machine learning model substantially improved our ability to predict IBD-related hospitalization and outpatient steroid use. This model could be used at point of care to distinguish patients at high and low risk for disease flare, allowing individualized therapeutic management.

Cited by 87 publications

References 28 publications

Application of Artificial Intelligence to Gastroenterology and Hepatology

Application of Artificial Intelligence to Gastroenterology and Hepatology

High circulating elafin levels are associated with Crohn’s disease-associated intestinal strictures

Association of Continuity of Care With Outcomes in US Veterans With Inflammatory Bowel Disease

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