Predicting endoscopic remission in Crohn's disease by the modified multiplier SES-CD (MM-SES-CD)
Predicting endoscopic remission in Crohn's disease by the modified multiplier SES-CD (MM-SES-CD)
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DOI：
10.1136/gutjnl-2020-323799
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发表时间：
2021-03-24
期刊：
影响因子：
24.5
通讯作者：
Dulai, Parambir S.
中科院分区：
文献类型：
--
作者：
Narula, Neeraj;Wong, Emily C. L.;Dulai, Parambir S.
克罗恩病简易内镜评分（SES-CD）是临床试验中测量粘膜炎症的主要工具，但缺乏预后潜力。我们着手开发和验证SES-CD的修改后的乘法器（MM-SES-CD），它考虑到每个单独的参数的预后价值，实现内镜缓解（ER），而积极治疗。（n=350例患者，基线SES-CD = 3，确认溃疡），汇总数据并随机分为70%训练组和30%测试组。MM-SES-CD是使用通过逻辑回归模型确定的单个参数的权重设计的，1年ER（SES-CD < 3）是因变量。低和高概率的ER的临界点得分确定通过使用最大的约登指数和验证在testing coherent.Results基线溃疡的大小，溃疡的程度和存在的非通过狭窄与1年ER相比，受影响的表面积，在Logistic回归过程中观察到的疾病段的个别参数的差异加权有最强的关联。使用该加权回归模型生成MM-SES-CD，并在训练数据集（受试者操作曲线下面积（AUC）0.83，95% CI 0.78 - 0.94）和测试数据集（AUC 0.82，95% CI 0.77 - 0.92）中显示出对ER的强区分度。在MM-SES-CD评分模型相比，原始的SES-CD评分缺乏准确性（AUC 0.60，95%CI 0.55至0.65）预测实现的ER。结论我们开发和内部验证的MM-SES-CD作为内镜严重程度评估工具，以预测一年的ER在积极治疗的CD患者。
Background and aims The Simple Endoscopic Score for Crohn's disease (SES-CD) is the primary tool for measurement of mucosal inflammation in clinical trials but lacks prognostic potential. We set to develop and validate a modified multiplier of the SES-CD (MM-SES-CD), which takes into consideration each individual parameter's prognostic value for achieving endoscopic remission (ER) while on active therapy.Methods In this posthoc analysis of three CD clinical trial programmes (n=350 patients, baseline SES-CD = 3 with confirmed ulceration), data were pooled and randomly split into a 70% training and 30% testing cohort. The MM-SES-CD was designed using weights for individual parameters as determined by logistic regression modelling, with 1-year ER (SES-CD < 3) being the dependent variable. A cut point score for low and high probability of ER was determined by using the maximum Youden Index and validated in the testing cohort.Results Baseline ulcer size, extent of ulceration and presence of non-passable strictures had the strongest association with 1-year ER as compared with affected surface area, with differential weighting of individual parameters across disease segments being observed during logistic regression. The MM-SES-CD was generated using this weighted regression model and demonstrated strong discrimination for ER in the training dataset (area under the receiver operator curve (AUC) 0.83, 95% CI 0.78 to 0.94) and in the testing dataset (AUC 0.82, 95% CI 0.77 to 0.92). In comparison to the MM-SES-CD scoring model, the original SES-CD score lacks accuracy (AUC 0.60, 95% CI 0.55 to 0.65) for predicting the achievement of ER.Conclusions We developed and internally validated the MM-SES-CD as an endoscopic severity assessment tool to predict one-year ER in patients with CD on active therapy.