Development and Validation of Risk Matrices for Crohn's Disease Outcomes in Patients Who Underwent Early Therapeutic Interventions.
BACKGROUND
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 [64% with disabling disease and 18% who needed reoperation], 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 significant 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 quantified by means of risk matrices, which are applicable as bedside clinical tools that can help physicians during therapeutic decisions in early disease management.
Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.|CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
Cláudia Camila
CC
Dias
Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.|CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
Pedro Pereira
PP
Rodrigues
Gastroenterology Department, Hospital São João, Porto, Portugal.
Rosa
R
Coelho
Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal.
Paula Moura
PM
Santos
Gastroenterology Department, Faculty of Medicine, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal.
Samuel
S
Fernandes
Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal.
Paula
P
Lago
Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal.
Cidalina
C
Caetano
Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal.
Ângela
Â
Rodrigues
Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Francisco
F
Portela
Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Ana
A
Oliveira
Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal.
Paula
P
Ministro
Gastroenterology Department, Centro Hospitalar Tondela e Viseu, Tondela e Viseu, Portugal.
Eugénia
E
Cancela
Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal.
Ana Isabel
AI
Vieira
Gastroenterology Department, Hospital Garcia da Orta, Lisboa, Portugal.
Rita
R
Barosa
Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
José
J
Cotter
Gastroenterology Department, Hospital de Faro, Faro, Portugal.
Pedro
P
Carvalho
Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal.
Isabelle
I
Cremers
Gastroenterology Department, Centro Hospitalar de Setúbal, Hospital São Bernardo, Setúbal, Portugal.
Daniel
D
Trabulo
Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.|Gastroenterology Department, Hospital de Faro, Faro, Portugal.
Paulo
P
Caldeira
Gastroenterology Department, Hospital de Faro, Faro, Portugal.
Artur
A
Antunes
Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal.
Isadora
I
Rosa
Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal.
Joana
J
Moleiro
Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal.
Paula
P
Peixe
Gastroenterology Department, Centro Hospitalar Lisboa Oriental Portugal, Lisboa, Portugal.
Rita
R
Herculano
Gastroenterology Department, Hospital de Braga, Braga, Portugal.
Raquel
R
Gonçalves
Gastroenterology Department, Hospital de Braga, Braga, Portugal.
Bruno
B
Gonçalves
Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.|Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal.
Helena Tavares
HT
Sousa
Gastroenterology Department, Portimão Unit, Centro Hospitalar do Algarve, Portimão, Portugal.
Luís
L
Contente
Gastroenterology Department, Hospital Nélio Mendonça, Funchal, Portugal.
Henrique
H
Morna
Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.
Susana
S
Lopes
Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.|Institute of Pharmacology and Therapeutics Faculty of Medicine of the University of Porto, Porto, Portugal.|MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.
Fernando
F
Magro
D000328:Adult; D001499:Bayes Theorem; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents
Crohn’s disease; Disabling disease; reoperation; risk matrices