Longitudinal Faecal Calprotectin Profiles Characterise Disease Course Heterogeneity in Crohn's Disease
Longitudinal Faecal Calprotectin Profiles Characterise Disease Course Heterogeneity in Crohn's Disease
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纵向粪便钙卫蛋白谱表征克罗恩病的病程异质性
DOI：
10.1101/2022.08.16.22278320
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Constantine-Cooke N
中科院分区：
文献类型：
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作者：
Constantine-Cooke N
背景粪便钙卫蛋白水平高与克罗恩病预后差相关。监测粪便钙卫蛋白的轨迹可以在严重的并发症发生之前阻止疾病进展。AimsWe进行了一个回顾性事件克罗恩病队列评估随时间推移粪便钙卫蛋白水平的个体间变异性的公正评估。我们的目的是探讨是否潜在的类，这样的配置文件与复合终点组成的手术，住院治疗，或蒙特利尔的行为进展和其他clinical information.MethodsLatent类混合模型被用来模拟粪便钙卫蛋白的轨迹在五年内的诊断。赤池信息准则，贝叶斯信息准则，冲积图，和类特定的轨迹被用来决定最佳的类数。Kaplan-Meier估计的对数秩检验被用来测试类成员和outcomes.ResultsOur研究队列包括365名受试者和2856粪便钙卫蛋白测量（中位数7每个主题）之间的关联。发现了四个潜在类别，并将其广泛描述为具有持续高粪便钙卫蛋白的类别和以钙卫蛋白下降趋势为特征的三个类别。分类成员资格与复合终点显著相关，分别与住院和蒙特利尔疾病进展相关，但与手术无关。早期生物治疗与类members.ConclusionsOur分析提供了一种新的分层方法克罗恩病患者的基础上粪便钙卫蛋白轨迹。描述这种异质性有助于更好地理解疾病进展的不同模式，并识别出那些具有更高风险的不良结局。最终，这些信息将有助于设计更有针对性的干预措施。
BackgroundHigh faecal calprotectin is associated with poor outcomes in Crohn’s disease. Monitoring of faecal calprotectin trajectories could characterise disease progression before severe complications occur.AimsWe undertook an unbiased assessment of a retrospective incident Crohn’s disease cohort to assess for inter-individual variability in faecal calprotectin levels over time. We aimed to explore whether latent classes of such profiles are associated with a composite endpoint consisting of surgery, hospitalisation, or Montreal behaviour progression and other clinical information.MethodsLatent class mixed models were used to model faecal calprotectin trajectories within five years of diagnosis. Akaike information criterion, Bayesian information criterion, alluvial plots, and class-specific trajectories were used to decide the optimal number of classes. Log-rank tests of Kaplan-Meier estimators were used to test for associations between class membership and outcomes.ResultsOur study cohort comprised 365 subjects and 2856 faecal calprotectin measurements (median 7 per subject). Four latent classes were found and broadly described as a class with consistently high faecal calprotectin and three classes characterised by downward trends for calprotectin. Class membership was significantly associated with the composite endpoint, and separately, hospitalisation and Montreal disease progression, but not surgery. Early biologic therapy was strongly associated with class membership.ConclusionsOur analysis provides a novel stratification approach for Crohn’s disease patients based on faecal calprotectin trajectories. Characterising this heterogeneity helps to better understand different patterns of disease progression and to identify those with a higher risk of worse outcomes. Ultimately, this information will assist the design of more targeted interventions.