A Validated Prognostic Model and Nomogram to Predict Early-Onset Complications Leading to Surgery in Patients With Crohn’s Disease

Abstract

BACKGROUND: Predicting aggressive Crohn’s disease is crucial for determining therapeutic strategies. OBJECTIVE: We aimed to develop a prognostic model to predict complications leading to surgery within 1 year after diagnosis of Crohn’s disease and to create a nomogram to facilitate clinical decision making. DESIGN: This is a retrospective study. SETTING: This study was conducted from January 2012 to December 2016 in a single tertiary IBD center. PATIENTS: Patients diagnosed with Crohn’s disease showing B1 behavior according to the Montreal classification were included. MAIN OUTCOME MEASURES: We measured the occurrence of complications that would ultimately lead to surgery, including severe GI bleeding (Glasgow-Blatchford score ≥6), stenosis, and perforations, confirmed by endoscopy, CT scan, and/or interventional radiology. RESULTS: The mean follow-up period was 54 months (SD 13 months). Of the 614 eligible patients, 13.5% developed complications leading to surgery. Multivariable logistic regression revealed the independent predictors of early-onset complications to be age (adjusted odds ratio per 10-year increase in age = 0.4; 95% CI, 0.2–0.8; p = 0.004), disease duration (adjusted odds ratio = 2.7, 95% CI, 1.9–3.8; p < 0.001), perianal disease (adjusted odds ratio = 16.0; 95% CI, 4.3–59.9; p < 0.001), previous surgery (adjusted odds ratio = 3.7; 95% CI, 1.6–8.6; p = 0.003), and extraintestinal manifestations (adjusted odds ratio = 7.6; 95% CI, 2.3–24.9; p = 0.001). The specificity and sensitivity of the prognostic model were 88.3% (95% CI, 84.8%–91.2%) and 96.6% (95% CI, 88.1%–99.6%), and the area under the curve was 0.97 (95% CI, 0.95–0.98). This model was validated with good discrimination and excellent calibration using the Hosmer-Lemeshow goodness-of-fit test. A nomogram was created to facilitate clinical bedside practice. LIMITATIONS: This was a retrospective design and included a small sample size from 1 center. CONCLUSIONS: Our validated prognostic model effectively predicted early-onset complications leading to surgery and screened aggressive Crohn’s disease, which will enable physicians to customize therapeutic strategies and monitor disease. See Video Abstract at http://links.lww.com/DCR/B442 . Registered at Chinese Clinical Trial Registry (ChiCTR1900025751). UN MODELO DE PRONÓSTICO VALIDADO Y UN NOMOGRAMA PARA PREDECIR COMPLICACIONES PRECOCES QUE REQUIRAN CIRUGÍA EN PACIENTES CON ENFERMEDAD DE CROHN ANTECEDENTES: Predecir una enfermedad de Crohn muy agresiva es fundamental para determinar la estrategia terapéutica. ...

Computed tomography‐based radiomics nomogram using machine learning for predicting 1‐year surgical risk after diagnosis of Crohn's disease

“…After multivariate logistic regression analysis (AIC = 153.9), a clinical‐characteristics‐only model (previous therapies of biologics and immunosuppressants, penetrating and stricturing behavior) was created and visualized as a nomogram (see Supplementary Figure S2). Of note, early onset surgery was defined as surgery within 1 year after diagnosis of CD, which was consistent with the definition of aggressive CD which we have defined in our previous studies 6,15 …”

“…They are recommended to undergo reevaluation for the risk of surgery at 1-year timepoint, which is considered to be an important timepoint for decision making supported by multiple trials. 6,15 Several clinical prognostic models have been established and applied in the context of IBD to aid in clinical decision-making. Yehyun et al reported a surgical risk-predictive model involving clinical parameters at diagnosis in the Korean CD population.…”

“…18 A study in America developed a nomogram to predict lateonset pouch failure in patients with ulcerative colitis who had undergone ileal pouch-anal anastomosis. 19 We have previously established nomograms predicting 1-year surgical risk 6 and the aggressive phenotype of CD 15 with clinical indices and endoscopic visualization scores evaluated. These models do not have satisfactory predictive accuracy without transmural evaluation by radiological examination.…”

Nomogram to predict permanent stoma in rectal cancer patients after sphincter-saving surgery

“…, lymph node metastasis, recurrence, and distant metastasis)[ 35 - 37 ]. In addition, some studies have used nomograms to predict the rate of postoperative complications, such as infection, anastomotic leakage, and stenosis[ 38 , 39 ]. Currently, only a few predictive models of PS for patients with rectal cancer have been published[ 40 - 42 ].…”

Timing of individualized surgical intervention in Crohn’s disease

“…The underlying cause of CD is still unknown but includes a variety of factors, including genetic susceptibility, environmental triggers, immune regulation, and gut microbial imbalance[ 7 - 9 ]. CD is prone to various complications due to penetrating and chronic intestinal inflammatory response, including intestinal obstruction, bowel perforation, fistula, or intra-abdominal abscess[ 10 , 11 ]. After diagnosis, approximately 50% and 70% of CD patients develop complications within 5 or 10 years, respectively[ 12 , 13 ].…”