Claudia Camila Dias1,2, Pedro Pereira Rodrigues1,2, Fernando Magro3,4,5
1Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of the University of Porto, Porto, Portugal, 2CINTESIS – Center for Health Tecnology and Services Research, Porto, Portugal, 3Gastroenterology Department, Hospital São João, Porto, Portugal, 4Institute of Pharmacology and Therapeutics Faculty of Medicine of the University of Porto, Porto, Portugal, 5MedInUP – Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
Introduction: The establishment of prognostic models for Crohn’s disease [CD] is highly desirable, as they have the potential to guide physicians in the decision-making process concerning therapeutic choices, thus improving patients’ health and quality of life. Our aim was to derive models for disabling CD and reoperation based solely on clinical/demographic data.
Methods: A multicentric and retrospectively enrolled cohort of CD patients, subject to early surgery or immunosuppression, was analysed in order to build Bayesian network models and risk matrices.The final results were validated internally and with a multicentric and prospectively enrolled cohort.
Results: The derivation cohort included a total of 489 CD patients, while the validation cohort included 129 CD patients with similar outcome proportions.The Bayesian models achieved an area under the curve of 78% for disabling disease and 86% for reoperation. Age at diagnosis, perianal disease, disease aggressiveness and early therapeutic decisions were found to be signi cant factors, and were used to construct user- friendly matrices depicting the probability of each outcome in patients with various combinations of these factors. The matrices exhibit good performance for the most important criteria: disabling disease positive post-test odds = 8.00 [2.72–23.44] and reoperation negative post-test odds = 0.02 [0.00–0.11].
Conclusions: Clinical and demographical risk factors for disabling CD and reoperation were determined and their impact was quanti ed by means of risk matrices, which are applicable as bedside clinical tools that can help physicians during therapeutic decisions in early disease management.
keywords: Disabling disease; reoperation; Crohn’s disease; risk matrices