Fernando Magro1,2,3, Cláudia Camila Dias4,5, Francisco Portela6, Mário Miranda6, Samuel Fernandes7, Sonia Bernardo7, Paula Ministro8, Paula Lago9, Isadora Rosa10, Inês Pita10, Luis Correia7, Pedro Pereira Rodrigues4,5. 1. Gastroenterology Department, Hospital São João, Porto, Portugal. 2. Institute of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Porto, Portugal. 3. Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal. 4. Department of Community Medicine, Information and Health Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal. 5. AI4Health group, Center for Health Technology and Services Research, Porto, Portugal. 6. Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. 7. Gastroenterology Department, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal. 8. Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela, Portugal. 9. Gastroenterology Department, Centro Hospitalar do Porto, Porto. Portugal. 10. Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal.
Abstract
BACKGROUND: Ulcerative colitis [UC] is a chronic inflammatory disease often accompanied by severe and distressing symptoms that, in some patients, might require a surgical intervention [colectomy]. This study aimed at determining the risk of experiencing progressive disease or requiring colectomy. MATERIAL AND METHODS: This was a multicentre study: patients' data [n = 1481] were retrieved from the Portuguese database of inflammatory bowel disease patients. Bayesian networks and logistic regression were used to build risk matrices concerning the outcomes of interest. RESULTS: The derivation cohort included a total of 1210 patients, of whom 6% required a colectomy and 37% had progressive disease [over a median follow-up period of 12 syears]. The risk matrices show that previously hospitalised patients with extensive disease, who are not on immunomodulators and who are refractory to corticosteroid treatment, are the ones at the highest risk of undergoing a colectomy [88%]; whereas male patients, with extensive disease and less than 40 years old at diagnosis, are the ones at the highest risk of experiencing progressive disease [72%]. These results were internally and externally validated, and the AUC [area under the curve] of the ROC [receiver operating characteristic] analysis for the derivation cohort yielded a high discriminative power [92% for colectomy and 72% for progressive disease]. CONCLUSIONS: This study allowed the construction of risk matrices that can be used to accurately predict a UC patient's likelihood of requiring a colectomy or of facing progressive disease, and can be used to individualise therapeutic strategies.
BACKGROUND: Ulcerative colitis [UC] is a chronic inflammatory disease often accompanied by severe and distressing symptoms that, in some patients, might require a surgical intervention [colectomy]. This study aimed at determining the risk of experiencing progressive disease or requiring colectomy. MATERIAL AND METHODS: This was a multicentre study: patients' data [n = 1481] were retrieved from the Portuguese database of inflammatory bowel diseasepatients. Bayesian networks and logistic regression were used to build risk matrices concerning the outcomes of interest. RESULTS: The derivation cohort included a total of 1210 patients, of whom 6% required a colectomy and 37% had progressive disease [over a median follow-up period of 12 syears]. The risk matrices show that previously hospitalised patients with extensive disease, who are not on immunomodulators and who are refractory to corticosteroid treatment, are the ones at the highest risk of undergoing a colectomy [88%]; whereas male patients, with extensive disease and less than 40 years old at diagnosis, are the ones at the highest risk of experiencing progressive disease [72%]. These results were internally and externally validated, and the AUC [area under the curve] of the ROC [receiver operating characteristic] analysis for the derivation cohort yielded a high discriminative power [92% for colectomy and 72% for progressive disease]. CONCLUSIONS: This study allowed the construction of risk matrices that can be used to accurately predict a UC patient's likelihood of requiring a colectomy or of facing progressive disease, and can be used to individualise therapeutic strategies.
Authors: David Marti-Aguado; María Pilar Ballester; Joan Tosca; Marta Maia Bosca-Watts; Pablo Navarro; Rosario Anton; Isabel Pascual; Francisco Mora; Miguel Minguez Journal: United European Gastroenterol J Date: 2019-05-29 Impact factor: 4.623
Authors: Fernando Magro; Catarina Alves; Mafalda Santiago; Paula Ministro; Paula Lago; Luís Correia; Raquel Gonçalves; Diana Carvalho; Francisco Portela; Cláudia Camila Dias; Axel Dignass; Silvio Danese; Laurent Peyrin-Biroulet; Maria Manuela Estevinho; Paula Moreira Journal: United European Gastroenterol J Date: 2021-12-14 Impact factor: 4.623