Researchers from The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China, have developed a prognostic model that effectively predicted early-onset complications leading to surgery and screened aggressive Crohn’s disease (CD), which will enable physicians to customise therapeutic strategies and monitor disease. They identified age, extraintestinal manifestations, previous surgery, perianal disease and disease duration as independent factors associated with complications leading to surgery in patients with Crohn’s Disease.
In their study, which were reported in the paper, ‘A Validated Prognostic Model and Nomogram to Predict Early-Onset Complications Leading to Surgery in Patients With Crohn’s Disease’, published in Diseases of the Colon & Rectum, the authors sought to develop a prognostic model to predict complications leading to surgery within one-year after diagnosis of Crohn’s disease and to create a nomogram to facilitate clinical decision making.
Their retrospective study collected data from patients in the IBD center of Sun Yat-Sun University Sixth Affiliated Hospital from January 2012 to December 2016. The main outcome of this study was the occurrence of complications that could lead to surgery, including severe GI bleeding, stenosis, and perforations. Predictive factors were selected from demographic and disease-related variables that were previously reported in the literature as potential factors.
A total of 614 patients newly diagnosed with CD with B1 behaviour were included in the study, 73.78% (n=453) of cases were men with a mean age of 26.8 (SD 10.9) years, mean disease duration of 1.3 (SD 1.6) years and mean follow-up period of 53.5 (SD 12.8) months. Eighty-three patients (13.5%) developed complications leading to surgery within one year after diagnosis. The most common complications were stenosis (n=48, 57.8%), followed by perforation (n=26, 31.3%) and severe GI bleeding (n=9, 10.8%). Seventy patients (84.3%) underwent a bowel segment resection, eight patients (9.6%) underwent stricturoplasty and five (6.0%) underwent a fistula repair.
The researchers reported that according to the univariate analysis, variables, including age at diagnosis, disease duration, previous surgery, perianal disease and extraintestinal manifestations, were significant factors related to early-onset complications.
Based on all the related variables in the multivariable logistic regression analysis, they developed a prognostic model that can precisely predict negative outcomes. It is the cornerstone in preventive and tailored therapeutics, especially for CD because of its complexity, the authors noted, and this model was based solely on clinical and demographic variables, making it easily and broadly applicable to the real-world setting.
“To our knowledge, this was the first prognostic model to integrate several factors, including extraintestinal manifestations and disease duration, to predict complications leading to surgery in patients with CD,” the authors concluded. “Undoubtedly, prospective studies with a broader population base are needed to validate our findings.”
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