Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
World J Gastroenterol. 2020 Feb 7;26(5):524-534. doi: 10.3748/wjg.v26.i5.524.
Accelerated therapeutic treatment should be considered in patients with progressive Crohn's disease (CD) to prevent complications as well as surgery. Therefore, screening for risk factors and predicting the need for early surgery are of great importance in clinical practice.
To establish a model to predict CD-related early surgery.
This was a retrospective study collecting data from CD patients diagnosed at our inflammatory bowel disease center from January 1, 2012 to December 31, 2016. All data were randomly stratified into a training set and a testing set at a ratio of 8:2. Multivariable logistic regression analysis was conducted with receiver operating characteristic curves constructed and areas under the curve calculated. This model was further validated with calibration and discrimination estimated. A nomogram was finally developed.
A total of 1002 eligible patients were enrolled with a mean follow-up period of 53.54 ± 13.10 mo. In total, 24.25% of patients received intestinal surgery within 1 year after diagnosis due to complications or disease relapse. Disease behavior (B2: OR [odds ratio] = 6.693, < 0.001; B3: OR = 14.405, < 0.001), smoking (OR = 4.135, < 0.001), body mass index (OR = 0.873, < 0.001) and C-reactive protein (OR = 1.022, = 0.001) at diagnosis, previous perianal (OR = 9.483, < 0.001) or intestinal surgery (OR = 8.887, < 0.001), maximum bowel wall thickness (OR = 1.965, < 0.001), use of biologics (OR = 0.264, < 0.001), and exclusive enteral nutrition (OR = 0.089, < 0.001) were identified as independent significant factors associated with early intestinal surgery. A prognostic model was established and further validated. The receiver operating characteristic curves and calculated areas under the curves (94.7%) confirmed an ideal predictive ability of this model with a sensitivity of 75.92% and specificity of 95.81%. A nomogram was developed to simplify the use of the predictive model in clinical practice.
This prognostic model can effectively predict 1-year risk of CD-related intestinal surgery, which will assist in screening progressive CD patients and tailoring therapeutic management.
对于进展期克罗恩病（CD）患者，应考虑加速治疗，以预防并发症和手术。因此，在临床实践中，筛查风险因素和预测早期手术的需求非常重要。
建立预测 CD 相关早期手术的模型。
这是一项回顾性研究，收集了 2012 年 1 月 1 日至 2016 年 12 月 31 日在我们炎症性肠病中心诊断的 CD 患者的数据。所有数据均随机分为训练集和测试集，比例为 8:2。采用多变量逻辑回归分析，构建受试者工作特征曲线并计算曲线下面积。该模型进一步通过校准和鉴别力评估进行验证。最终开发了一个列线图。
共纳入 1002 例符合条件的患者，平均随访时间为 53.54±13.10 个月。共有 24.25%的患者因并发症或疾病复发在诊断后 1 年内接受了肠道手术。疾病行为（B2：OR[比值比]=6.693，<0.001；B3：OR=14.405，<0.001）、吸烟（OR=4.135，<0.001）、体质量指数（OR=0.873，<0.001）和 C 反应蛋白（OR=1.022，=0.001）在诊断时，先前的肛周（OR=9.483，<0.001）或肠道手术（OR=8.887，<0.001），最大肠壁厚度（OR=1.965，<0.001），使用生物制剂（OR=0.264，<0.001）和肠内营养（OR=0.089，<0.001）被确定为与早期肠道手术相关的独立显著因素。建立并进一步验证了一个预测模型。受试者工作特征曲线和计算的曲线下面积（94.7%）证实了该模型具有理想的预测能力，灵敏度为 75.92%，特异性为 95.81%。开发了一个列线图，以简化临床实践中预测模型的使用。
该预测模型可有效预测 1 年内 CD 相关肠道手术的风险，有助于筛选进展期 CD 患者并制定治疗管理策略。
