Peter L Lakatos1, Nora Sipeki2, Gyorgy Kovacs2, Eszter Palyu2, Gary L Norman3, Zakera Shums3, Petra A Golovics4, Barbara D Lovasz4, Peter Antal-Szalmas5, Maria Papp2. 1. 1st Department of Medicine, Semmelweis University, Budapest, Hungary lakatos.peter_laszlo@med.semmelweis-univ.hu. 2. Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary. 3. Inova Diagnostics, Inc., San Diego, CA, USA. 4. 1st Department of Medicine, Semmelweis University, Budapest, Hungary. 5. Department of Laboratory Medicine, University of Debrecen, Clinical Center, Debrecen, Hungary.
Abstract
BACKGROUND: Early identification of patients with Crohn's disease (CD) at risk of subsequent complications is essential for adapting the treatment strategy. We aimed to develop a prediction model including clinical and serological markers for assessing the probability of developing advanced disease in a prospective referral CD cohort. METHODS: Two hundred and seventy-one consecutive CD patients (42.4% males, median follow-up 108 months) were included and followed up prospectively. Anti-Saccharomyces cerevisiae antibodies (ASCA IgA/IgG) were determined by enzyme-linked immunosorbent assay. The final analysis was limited to patients with inflammatory disease behaviour at diagnosis. The final definition of advanced disease outcome was having intestinal resection or disease behaviour progression. RESULTS: Antibody (ASCA IgA and/or IgG) status, disease location and need for early azathioprine were included in a 3-, 5- and 7-year prediction matrix. The probability of advanced disease after 5 years varied from 6.2 to 55% depending on the combination of predictors. Similar findings were obtained in Kaplan-Meier analysis; the combination of ASCA, location and early use of azathioprine was associated with the probability of developing advanced disease (p < 0.001, log rank test). CONCLUSIONS: Our prediction models identified substantial differences in the probability of developing advanced disease in the early disease course of CD. Markers identified in this referral cohort were different from those previously published in a population-based cohort, suggesting that different prediction models should be used in the referral setting.
BACKGROUND: Early identification of patients with Crohn's disease (CD) at risk of subsequent complications is essential for adapting the treatment strategy. We aimed to develop a prediction model including clinical and serological markers for assessing the probability of developing advanced disease in a prospective referral CD cohort. METHODS: Two hundred and seventy-one consecutive CDpatients (42.4% males, median follow-up 108 months) were included and followed up prospectively. Anti-Saccharomyces cerevisiae antibodies (ASCA IgA/IgG) were determined by enzyme-linked immunosorbent assay. The final analysis was limited to patients with inflammatory disease behaviour at diagnosis. The final definition of advanced disease outcome was having intestinal resection or disease behaviour progression. RESULTS: Antibody (ASCA IgA and/or IgG) status, disease location and need for early azathioprine were included in a 3-, 5- and 7-year prediction matrix. The probability of advanced disease after 5 years varied from 6.2 to 55% depending on the combination of predictors. Similar findings were obtained in Kaplan-Meier analysis; the combination of ASCA, location and early use of azathioprine was associated with the probability of developing advanced disease (p < 0.001, log rank test). CONCLUSIONS: Our prediction models identified substantial differences in the probability of developing advanced disease in the early disease course of CD. Markers identified in this referral cohort were different from those previously published in a population-based cohort, suggesting that different prediction models should be used in the referral setting.
Authors: Gyorgy Kovacs; Nora Sipeki; Boglarka Suga; Tamas Tornai; Kai Fechner; Gary L Norman; Zakera Shums; Peter Antal-Szalmas; Maria Papp Journal: PLoS One Date: 2018-03-28 Impact factor: 3.240