Disabling and Reoperation in Patients with Crohn's Disease Subject to Early Surgery or Immunosuppression: A Bayesian Network Prognostic Model

Abstract Background 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 is of great importance in clinical practice. We aimed to establish a model to predict CD-related early surgery. Methods This was a retrospective study collecting data from CD patients diagnosed in our inflammatory bowel disease (IBD) centre from 1 January 2012 to 31 December 2016. All data were randomly stratified into a training set and a validation set at a ratio of 8:2. Multiple logistic regression analysis was conducted with receiver operating characteristic (ROC) curves constructed and areas under the curve (AUC) calculated. This model was further validated with a nomogram developed. Results A total of 1002 eligible patients were enrolled with a mean follow-up period of 53.54 ± 13.10 months. In total, 24.25% of patients received intestinal surgery within 1 year after diagnosis due to complications or disease relapse. Disease behaviour (B2: OR 6.693, p < 0.001; B3: OR 14.405, p < 0.001), smoking (OR 4.135, p < 0.001), BMI (OR 0.873, p < 0.001) and CRP (OR 1.022, p = 0.001) at diagnosis, previous perianal (OR 9.483, p < 0.001) or intestinal surgery (OR 8.887, p < 0.001), maximum bowel wall thickness (OR 1.965, p < 0.001), use of biologics (OR 0.264, p < 0.001), and exclusive enteral nutrition (OR 0.089, p < 0.001) were identified as independent significant factors associated with early intestinal surgery. A prognostic model was established as follows: X1 = maximum BWT [mm]; X2 = smoking [0: no, 1: yes]; X3 = BMI at diagnosis [m/kg2]；X4 = previous perianal surgery [0: no, 1: yes]; X5 = previous intestinal surgery [0: no, 1: es]; X6 = disease type (stricturing or penetrating disease); X7 = use of biologics; X8 = use of EEN; X9 = CRP at diagnosis). ROC curve and calculated AUC (94.7%) confirmed an ideal predictive ability of this model with a sensitivity of 75.92% and specificity of 95.81%. Nomogram was developed to simplify the use of predictive model in clinical daily practice. Conclusion This prognostic model can effectively predict 1-year risk of CD-related intestinal surgery, which will assist in screening progressive CD patients and aid in tailoring therapeutic management.

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Early Surgery Versus Biologic Therapy in Limited Nonstricturing Ileocecal Crohn’s Disease—A Decision-making Analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz282 ◽

2020 ◽

Vol 26 (11) ◽

pp. 1648-1657

Author(s):

Efrat Broide ◽

Adi Eindor-Abarbanel ◽

Timna Naftali ◽

Haim Shirin ◽

Tzippora Shalem ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Markov Model ◽

Treatment Strategy ◽

Early Surgery ◽

Published Data ◽

Model Parameters ◽

Decision Analysis Model ◽

Biologic Treatment ◽

Life Years

Abstract Background Surgery is the preferred option for patients with symptomatic localized fibrostenotic ileocecal Crohn’s disease (CD) but not for those with predominantly active inflammation without obstruction. The benefit of early surgery in patients with a limited nonstricturing ileocecal CD over biologic treatment is still a debate. Objective Our objective is to formulate a decision analysis model based on recently published data to explore whether early surgery in patients with limited nonstricturing CD is preferred over biologic treatment. Methods We constructed a Markov model comparing 2 strategies of treatment: (1) early surgery vs (2) biologic treatment. To estimate the quality-adjusted life years (QALYs) and the costs in each strategy, we simulated 10,000 virtual patients with the Markov model using a Monte Carlo simulation 100 times. Sensitivity analyses were performed to evaluate the robustness of the model and address uncertainties in the estimation of model parameters. Results The costs were $29,457 ± $407 and $50,382 ± $525 (mean ± SD) for early surgery strategy and biologic treatment strategy, respectively. The QALY was 6.24 ± 0.01 and 5.81 ± 0.01 for early surgery strategy and biologic treatment strategy, respectively. Conclusion The strategy of early surgery dominates (higher QALY value [efficacy] and less cost) compared with the strategy of biologic treatment in patients with limited ileocecal CD.

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Sa1255 The Comparative Efficacy of Induction of Remission for Mesalamine, Sulfasalazine, and Budesonide for the Treatment of Mild to Moderate Crohn's Disease: A Bayesian Network Meta-Analysis

Gastroenterology ◽

10.1016/s0016-5085(15)30895-7 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-271

Author(s):

Stephanie Coward ◽

Ellen Kuenzig ◽

Glen Hazlewood ◽

Rebecca Holmes ◽

Remo Panaccione ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Bayesian Network ◽

Meta Analysis ◽

Comparative Efficacy

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P-024 YI The Incidence of Crohn’s Disease and Rate of Early Surgery in the U.S. Military Health Care System

Inflammatory Bowel Diseases ◽

10.1097/01.mib.0000456783.42023.9e ◽

2014 ◽

Vol 20 ◽

pp. S32

Author(s):

Cunningham Scott ◽

Maydonovitch Corinne ◽

Betteridge John

Keyword(s):

Health Care ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Health Care System ◽

Early Surgery ◽

Military Health ◽

Military Health Care ◽

The U.S ◽

Care System

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P160 Can the Lemann index at diagnosis predict the risk of early surgery in Crohn’s disease?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.287 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S239-S239

Author(s):

A Hassine ◽

I Akkari ◽

S Mrabet ◽

E Ben Jazia

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Treatment Decision ◽

Early Surgery ◽

First Year ◽

Rapid Disease Progression ◽

Significant Difference ◽

The Mean ◽

Optimal Patient Management

Abstract Background Identifying patients with Crohn’s disease (CD) with rapid disease progression or at high risk for early surgery is a crucial pillar in the treatment decision to ensure optimal patient management. The objective of this study was to assess the correlation between the Lemann index at the time of diagnosis and abdominal surgery in the first year after diagnosis of Crohn’s disease and to find the risk factors for early surgery. Methods This is a retrospective study of all patients with CD followed in our center over a period of 4 years (January 2016- January 2020), and who were evaluated by endoscopy and MRI at baseline. The Lemann Index is a score that measures cumulative damage to digestive tissue from entero-MRI and endoscopy data. It was calculated by noting the previous surgery, the location and extension of the disease and any intestinal complications. The sociodemographic and clinical characteristics of the patients were studied. Hypothesis tests were applied to identify associations. Results 112 patients with CD were included in this study, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. Anoperineal manifestations were noted in 24 patients. An upper digestive tract was present in 19.6% of patients. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. During the first year after diagnosis of CD, 19.6% of patients (n = 22) required surgical treatment. The indications for surgery were: the presence of an intra-abdominal collection (27.3%), severe acute corticosteroid-resistant colitis (18.2%); ileocaecal stenosis resistant to medical treatment (27.3%) or acute bowel obstruction (27.3%). The LI at diagnosis was much higher in the early surgery group: 5.22 +/- 2.65 vs. 2.63 +/- 1.88; with a statistically significant difference (p = 0.01). A severe initial flare as well as a penetrating phenotype were predictors of early abdominal surgery (p = 0.022, p = 0.024, respectively). Conclusion According to our study, a high Lemann score at diagnosis correlates well with the risk of early surgery in Crohn’s disease. Further, larger-scale studies would be needed to establish the reliability of this test in predicting this risk.

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