Development and validation of a novel model based on clinical characteristics to predict natural disease course progression in patients with stricturing Crohn's disease.

BACKGROUND

Stricturing Crohn's disease (CD) is heterogeneous, and risk factors for natural disease course progression remain unclear.

OBJECTIVES

The study aims to construct a predictive model based on commonly used clinical indicators to identify high-risk stricturing CD prone to natural disease course progression.

DESIGN

Retrospective multicenter study.

METHODS

We conducted a retrospective analysis of clinical data from stricturing CD patients. The natural disease course progression was defined as progression to penetrating disease or surgery. The data were split into a test cohort and an internal validation cohort in a 7:3 ratio. Classification models, including logistic regression (LR), random forest (RF), and extreme gradient Boosting (XGB) models, were constructed and validated in an independent external validation cohort.

RESULTS

The study included 341 patients, with 190 in the internal training cohort, 81 in the test cohort, and 70 in the external validation cohort. Obstructive symptoms, globulin (GLB), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) are independent predictors of natural disease course progression. LR, RF, and XGB models were developed to predict the occurrence of natural disease course progression within 2 years. In the internal test cohort, the areas under the receiver-operating characteristic curves of the LR, RF, and XGB models were 0.861, 0.492, and 0.559, respectively. In the external validation cohort, the LR model also achieved the highest area under the receiver operating characteristic curve value of 0.752.

CONCLUSION

In patients with stricturing CD, obstructive symptoms score, CRP, ESR, and GLB were independent and validated predictors of natural disease course progression. A prognostic nomogram based on the LR model was developed to aid in evaluating the prognosis of stricturing CD patients.