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The risk of disabling, surgery and reoperation in Crohn's disease - A decision tree-based approach to prognosis
Cláudia Camila Dias1,2, Pedro Pereira Rodrigues1,2, Samuel Fernandes3
1Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of the University of Porto, Porto, Portugal.
Insights
This study developed a decision-tree approach to predict Crohn's disease (CD) patient risks for disabling events, surgery, and reoperation using clinical and demographic data. The model accurately identifies high-risk patients, aiding in personalized treatment strategies.
Area of Science:
- Gastroenterology
- Medical Informatics
- Clinical Decision Support
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease with a high risk of disabling complications and surgical intervention.
- Predicting these adverse outcomes is crucial for effective patient management and treatment planning.
Purpose of the Study:
- To develop and validate a decision-tree based approach for assessing the risk of disabling events, surgical interventions, and reoperations in Crohn's disease patients.
- To utilize clinical and demographic variables for risk stratification.
Main Methods:
- A multicentric study involving 1547 Crohn's disease patients, retrospectively divided into derivation (80%) and validation (20%) cohorts.
- Application of the CHAIRT algorithm to build decision trees based on selected clinical and demographic variables.
- Receiver operating characteristic (ROC) analysis to evaluate the predictive performance of the decision trees.
Main Results:
- Three-level decision trees were constructed for disabling events and reoperation risk; a two-level tree was developed for surgery risk.
- All models demonstrated high predictive accuracy with Area Under the Curve (AUC) > 70%.
- Specific risk cut-offs were identified, showing significant predictive value for disabling events (positive odds test 4.06), surgery exclusion (negative odds test 0.15), and reoperation exclusion (negative odds test 0.50).
- Patient phenotype (B2/B3) correlated with higher disabling disease and surgery risk, while delayed pharmacological therapy introduction post-surgery increased reoperation risk.
Conclusions:
- The decision-tree based approach using demographic and clinical variables is a valid and useful tool for depicting risks associated with disabling events, surgery, and reoperation in Crohn's disease.
- This method can aid clinicians in identifying at-risk patients and tailoring management strategies.
Introduction:
Crohn's disease (CD) is a chronic inflammatory bowel disease known to carry a high risk of disabling and many times requiring surgical interventions. This article describes a decision-tree based approach that defines the CD patients' risk or undergoing disabling events, surgical interventions and reoperations, based on clinical and demographic variables.
Materials And Methods:
This multicentric study involved 1547 CD patients retrospectively enrolled and divided into two cohorts: a derivation one (80%) and a validation one (20%). Decision trees were built upon applying the CHAIRT algorithm for the selection of variables.
Results:
Three-level decision trees were built for the risk of disabling and reoperation, whereas the risk of surgery was described in a two-level one. A receiver operating characteristic (ROC) analysis was performed, and the area under the curves (AUC) Was higher than 70% for all outcomes. The defined risk cut-off values show usefulness for the assessed outcomes: risk levels above 75% for disabling had an odds test positivity of 4.06 [3.50-4.71], whereas risk levels below 34% and 19% excluded surgery and reoperation with an odds test negativity of 0.15 [0.09-0.25] and 0.50 [0.24-1.01], respectively. Overall, patients with B2 or B3 phenotype had a higher proportion of disabling disease and surgery, while patients with later introduction of pharmacological therapeutic (1 months after initial surgery) had a higher proportion of reoperation.
Conclusions:
The decision-tree based approach used in this study, with demographic and clinical variables, has shown to be a valid and useful approach to depict such risks of disabling, surgery and reoperation.
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