Effect of fuzzy partitioning in Crohn’s disease classification: a neuro-fuzzy-based approach

Abstract Background There is lack of real-world data for disease behavior and surgery of Crohn’s disease (CD) from large-scale Chinese cohorts. Methods Hospitalized patients diagnosed with CD in our center were consecutively included from January 2000 to December 2018. Disease behavior progression was defined as the initial classification of B1 to the progression to B2 or B3. Clinical characteristics including demographics, disease classification and activity, medical therapy, development of cancers, and death were collected. Results Overall, 504 patients were included. Two hundred and thirty one (45.8%) patients were initially classified as B1; 30 (13.0%), 71 (30.7%), and 95 (41.1%) of them had disease progression at the 1-year follow-up, 5-year follow-up, and overall, respectively. Patients without location transition before behavior transition were less likely to experience behavior progression. However, patients without previous exposure to a corticosteroid, immunomodulator, or biological agent had a greater chance of experiencing behavior progression. When the long-term prognosis was evaluated, 211 (41.9%) patients underwent at least one CD-related surgery; 108 (21.4%) and 120 (23.8%) of these patients underwent surgery before and after their diagnosis, respectively. An initial classification as B1, no behavior transition, no surgery prior to diagnosis, and previous corticosteroid exposure during follow-up were associated with a lower risk of undergoing surgery. Conclusions This study depicts the clinical features and factors associated with behavior progression and surgery among hospitalized CD patients in a Chinese center. Behavior progression is associated with a higher probability of CD-related surgery, and strengthened therapies are necessary for them in the early phase.

Download Full-text

Classifying Crohn’s disease into colon-involving versus non-colon-involving groups is a better predictor of clinical outcomes than the Montreal classification

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820968732 ◽

2020 ◽

Vol 13 ◽

pp. 175628482096873

Author(s):

Si-Nan Lin ◽

Dan-Ping Zheng ◽

Yun Qiu ◽

Sheng-Hong Zhang ◽

Yao He ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Clinical Outcomes ◽

Protective Factor ◽

Age Of Onset ◽

Disease Classification ◽

Major Abdominal Surgery ◽

Montreal Classification

Background: A suitable disease classification is essential for individualized therapy in patients with Crohn’s disease (CD). Although a potential mechanistic classification of colon-involving and non-colon-involving disease was suggested by recent genetic and microbiota studies, the clinical implication has seldom been investigated. We aimed to explore the association of this colonic-based classification with clinical outcomes in patients with CD compared with the Montreal classification. Methods: This was a retrospective study of CD patients from a tertiary referral center. Patients were categorized into colon-involving and non-colon-involving disease, and according to the Montreal classification. Clinico-demographic data, medications, and surgeries were compared between the two classifications. The primary outcome was the need for major abdominal surgery. Results: Of 934 patients, those with colonic involvement had an earlier median (interquartile range) age of onset [23.0 (17.0–30.0) versus 26.0 (19.0–35.0) years, p = 0.001], higher frequency of perianal lesions (31.2% versus 14.5%, p < 0.001) and extraintestinal manifestations (21.8% versus 14.5%, p = 0.010), but lower frequency of stricture (B2) (16.3% versus 24.0%, p = 0.005), than those with non-colon-involving disease. Colon-involving disease was a protective factor against major abdominal surgery [hazard ratio, 0.689; 95% confidence interval (CI), 0.481–0.985; p = 0.041]. However, patients with colon-involving CD were more prone to steroids [odds ratio (OR), 1.793; 95% CI, 1.206–2.666; p = 0.004] and azathioprine/6-mercaptopurine (AZA/6-MP) treatment (OR, 1.732; 95% CI, 1.103–2.719; p = 0.017) than were patients with non-colon-involving disease. The Montreal classification was not predictive of surgery or steroids and AZA/6-MP treatment. Conclusion: This study supports the rationale for disease classification based on the involvement of colon. This new classification of CD is a better predictor of clinical outcomes than the Montreal classification.

Download Full-text

Perianal Crohn's disease: Classification and clinical evaluation

Digestive and Liver Disease ◽

10.1016/j.dld.2007.07.153 ◽

2007 ◽

Vol 39 (10) ◽

pp. 959-962 ◽

Cited By ~ 38

Author(s):

S. Vermeire ◽

G. Van Assche ◽

P. Rutgeerts

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Evaluation ◽

Disease Classification ◽

Perianal Crohn’S Disease ◽

Perianal Crohn's Disease

Download Full-text

A Novel System for Multi-level Crohn’s Disease Classification and Grading Based on a Multiclass Support Vector Machine

Progresses in Artificial Intelligence and Neural Systems - Smart Innovation, Systems and Technologies ◽

10.1007/978-981-15-5093-5_18 ◽

2020 ◽

pp. 185-197

Author(s):

S. Franchini ◽

M. C. Terranova ◽

G. Lo Re ◽

M. Galia ◽

S. Salerno ◽

...

Keyword(s):

Support Vector Machine ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Classification ◽

Support Vector ◽

Multiclass Support Vector Machine ◽

Multi Level

Download Full-text

A Kernel Support Vector Machine Based Technique for Crohn’s Disease Classification in Human Patients

Advances in Intelligent Systems and Computing - Complex, Intelligent, and Software Intensive Systems ◽

10.1007/978-3-319-61566-0_25 ◽

2017 ◽

pp. 262-273 ◽

Cited By ~ 5

Author(s):

Albert Comelli ◽

Maria Chiara Terranova ◽

Laura Scopelliti ◽

Sergio Salerno ◽

Federico Midiri ◽

...

Keyword(s):

Support Vector Machine ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Classification ◽

Support Vector ◽

Kernel Support Vector Machine

Download Full-text

Evaluation of a Support Vector Machine Based Method for Crohn’s Disease Classification

Neural Approaches to Dynamics of Signal Exchanges - Smart Innovation, Systems and Technologies ◽

10.1007/978-981-13-8950-4_29 ◽

2019 ◽

pp. 313-327

Author(s):

S. Franchini ◽

M. C. Terranova ◽

G. Lo Re ◽

S. Salerno ◽

M. Midiri ◽

...

Keyword(s):

Support Vector Machine ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Classification ◽

Support Vector

Download Full-text

P196 Colon-involving versus non-colon-involving Crohn’s disease classification: is the Montreal classification outdated?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.322 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S262-S262

Author(s):

T Capela ◽

V Macedo Silva ◽

M Freitas ◽

T Cúrdia Gonçalves ◽

F Dias de Castro ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Adverse Outcomes ◽

Disease Classification ◽

Need For Treatment ◽

Montreal Classification ◽

Disease Extension ◽

Disease Behavior ◽

Disease Location

Abstract Background An appropriate disease classification is essential for the management of Crohn’s disease (CD) patients. Recently, a new classification of colon-involving versus non-colon-involving disease extension was considered to be more predictive of adverse outcomes than the Montreal classification (MRC). We aimed to investigate the association of a colon-based classification with clinically relevant outcomes in patients with CD compared with the MRC. Methods Retrospective cohort-study which consecutively included adult CD patients with at least 1 year of follow-up. Patients were categorized into colon-involving and non-colon-involving disease and according to the MRC. Patients’ demographic, clinical, biochemical, and imaging data were recorded and compared between the two classifications. The primary outcome was the need for treatment with steroids or biologics, hospitalization and major abdominal surgery. Results Of 327 patients, 52.3% were female with a mean age of 43.3±13.1 years. The most common disease location according to MRC was L1 (48.9%), followed by L3 (41.3%) and L2 (9.8%). Overall, 51.1% of patients had colon-involving disease. Although patients with colon-involvement at diagnosis had higher frequency of perianal lesions (27.5% vs 16.9%, P<0.05) and serum inflammatory biomarkers (lower hemoglobin, and higher leucocyte and platelet counts, c-reactive protein and erythrocyte sedimentation rate), this classification was not predictive of relevant outcomes. Considering the two types of colon-involving disease (L2, L3), patients with L2 disease had higher extraintestinal manifestations (43.8% vs 20.7%, respectively, P<0.05), higher B1 disease behavior (87.5% vs 58.5%, respectively, P<0.05) and lower B2 disease behavior (6.25% vs 22.2%, respectively, P<0.05). Disease location according to MRC was predictive of the need for treatment with biologics, hospitalization and major abdominal surgery in univariate analysis, but not in multivariate analysis. Conclusion Although simpler, defining Crohn’s disease extension by colon-involving versus non-colon-involving is not more predictive of adverse outcomes than the Montreal classification. Therefore, the use of Montreal Classification should still be considered essential in the adequate management of IBD patients.

Download Full-text

P074 Crohn’s disease clinical data standards: Adoption and implementation to promote data sharing and reuse

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.203 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S177-S177

Author(s):

J Owen

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Data ◽

Development Process ◽

Disease Classification ◽

Data Standards ◽

Adoption And Implementation ◽

Standards Adoption ◽

Standards Development ◽

Education Courses

Abstract Background Creation and adoption of clinical data standards will transform incompatible and disparate data into universal and illuminating information, facilitating discoveries that could have invaluable impact on Crohn’s Disease clinical research. Implementation of CDISC standards deliver on the promise of FAIR data through consistent organization and analysis that allow all researchers to leverage information from studies globally. Methods With support from The Leona M. and Harry B. Helmsley Charitable Trust and following the CDISC consensus-based standards development process, a team of Crohn’s disease and standards development experts was created to develop clinical data standards for Crohn’s disease.The CDISC standards development process consists of five stages: Results Free and publicly available data standards are anticipated to be available in May 2021 in the following areas: - Questionnaires, Ratings and Scales (including standard symptom measures, patient/investigator reported outcomes, and socio-economic measures) - Prior and Baseline, and On-Study Treatments (including response to prior treatment) - Disease Classification (location and phenotypic descriptions of the disease)- Endoscopy Assessments - Cross Section Imaging Assessments (including CT, MRI and Ultrasound) - Histopathology of Biopsy Samples - Biomarkers of Interest for Crohn’s Disease Conclusion Widespread promotion of the standards for researchers to adopt and implement is of highest importance. CDISC provides complementary education courses and implementation information to assist in adoption for academic teams new to CDISC standards. Widespread adoption of the standards will bring clarity to Crohn’s Disease data and will enable the accessibility, interoperability, and reusability of data (FAIR).

Download Full-text