Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic.
Pediatr Res. 2023 May;93(6):1659-1666. doi: 10.1038/s41390-022-02270-x. Epub 2022 Aug 25.
Maintaining of remission early in the disease course of Crohn's disease (CD) is essential and has major impact on the future prognosis. This study aimed to identify baseline predictors to develop model allowing stratification of patients who will not benefit from long-term azathioprine (AZA) treatment and will require more intensive therapy.
This study was designed to develop clinical prediction rule using retrospective data analysis of pediatric CD patients included in prospective inception cohort. Clinical relapse was defined as necessity of re-induction of remission. Sequence of Cox models was fitted to predict risk of relapse.
Out of 1190 CD patients from 13 European centers, 441 were included, 50.3% patients did not experience clinical relapse within 2 years of AZA treatment initiation. Median time to relapse was 2.11 (CI 1.59-2.46) years. Of all the tested parameters available at diagnosis, six were significant in multivariate analyses: C-reactive protein (p = 0.038), body mass index Z-score >0.8 SD (p = 0.002), abnormal sigmoid imaging (p = 0.039), abnormal esophageal endoscopy (p = 0.005), ileocolonic localization (p = 0.023), AZA dose in specific age category (p = 0.031).
Although the possibility of predicting relapse on AZA treatment appears limited, we developed predictive model based on six baseline parameters potentially helpful in clinical decision.
The possibility of predicting relapse on AZA treatment appears to be possible but limited. We identified six independent predictors available at diagnosis of early AZA/6-MP treatment failure in pediatric CD patients. Using combination of these factors, a model applicable to clinical practice was created. A web-based tool, allowing estimation of individual relapse risk in pediatric CD patients on a particular therapeutic regimen, has been developed.
在克罗恩病（CD）的疾病早期维持缓解状态至关重要，并且对未来的预后有重大影响。本研究旨在确定基线预测因子，以建立一种模型，对那些不能从长期硫唑嘌呤（AZA）治疗中获益且需要更强化治疗的患者进行分层。
本研究旨在通过回顾性分析纳入前瞻性起始队列的儿科 CD 患者的回顾性数据分析，来开发临床预测规则。临床复发定义为需要重新诱导缓解。使用 Cox 模型序列来预测复发风险。
在来自 13 个欧洲中心的 1190 例 CD 患者中，有 441 例患者被纳入，其中 50.3%的患者在开始 AZA 治疗后的 2 年内未经历临床复发。复发的中位时间为 2.11（CI 1.59-2.46）年。在所有可用于诊断的测试参数中，有 6 个在多变量分析中具有统计学意义：C 反应蛋白（p=0.038）、体重指数 Z 评分>0.8SD（p=0.002）、异常乙状结肠影像学（p=0.039）、异常食管内镜检查（p=0.005）、回结肠定位（p=0.023）、特定年龄组的 AZA 剂量（p=0.031）。
尽管预测 AZA 治疗后复发的可能性似乎有限，但我们基于 6 个基线参数建立了预测模型，这些参数可能有助于临床决策。
预测 AZA 治疗后复发的可能性似乎是可能的，但有限。我们在儿科 CD 患者早期 AZA/6-MP 治疗失败时确定了 6 个独立的预测因子。通过使用这些因素的组合，创建了一种适用于临床实践的模型。开发了一种基于网络的工具，可用于估计儿科 CD 患者在特定治疗方案下的个体复发风险。
