title: Risk Matrix for Prediction of Disease Progression in a Referral Cohort of Patients with Crohn's Disease.
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.
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary lakatos.peter_laszlo@med.semmelweis-univ.hu.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Lakatos
authors.affiliation: Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary.
authors.forename: Nora
authors.initials: N
authors.lastname: Sipeki
authors.affiliation: Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary.
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Kovacs
authors.affiliation: Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Palyu
authors.affiliation: Inova Diagnostics, Inc., San Diego, CA, USA.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Norman
authors.affiliation: Inova Diagnostics, Inc., San Diego, CA, USA.
authors.forename: Zakera
authors.initials: Z
authors.lastname: Shums
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Petra A
authors.initials: PA
authors.lastname: Golovics
authors.affiliation: 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Lovasz
authors.affiliation: Department of Laboratory Medicine, University of Debrecen, Clinical Center, Debrecen, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Antal-Szalmas
authors.affiliation: Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary.
authors.forename: Maria
authors.initials: M
authors.lastname: Papp
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: ASCA; Crohn’s disease; Serological antibodies; disease progression; referral cohort; azathioprine