Materiały źródłowe

• #1 Prognosis of Crohn’s Disease: Mortality Risk and Management

  https://www.healthline.com/health/prognosis-of-crohn-disease

  Crohns disease is a lifelong chronic condition that differs from person to person, requiring various treatments. Theres currently no cure for Crohns disease. […] People with Crohns disease do have a higher risk of death from related causes than the general population. People with Crohns disease have a polled mortality rate of 1.4 to 1.5 compared to the general population. […] However, people with the condition itself and no additional complications have a similar life expectancy to people without the condition. […] While theres no known cure for Crohns disease, many people with this condition live full and happy lives.

• #2 Crohn’s Disease: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/9357-crohns-disease

  There isnt a cure for Crohns disease. Once youre diagnosed, youll work closely with your healthcare provider to treat the disease, manage symptoms and prevent complications. Treatment can promote your long-term health. […] Most people with Crohns disease enjoy full, active lives. Treatments and lifestyle changes can keep the disease in remission (no signs or symptoms of the disease) and prevent complications. Most people with Crohns benefit from ongoing medical therapy and visits. […] Crohns disease isnt fatal, and people with Crohns disease can live just as long as people without it. Still, managing your condition to prevent complications is important since Crohns can increase your risk of certain conditions. For example, regular colonoscopies can catch colon cancer early when its treatable.

• #3 Crohn’s Disease Prognosis & Life Expectancy | Living With Crohn’s

  https://resources.healthgrades.com/right-care/crohns-disease/crohns-disease-prognosis-and-life-expectancy

  Crohn’s disease is a chronic inflammatory bowel disease (IBD). There’s still no cure for Crohn’s, but with medical treatment, most people are able to continue the activities they enjoy and live long, fulfilling lives. Here’s what to know about living with Crohn’s disease and the new research and treatments that are offering hope and improving Crohn’s disease prognosis. […] It’s impossible to predict exactly how Crohn’s disease will affect your life. Each person is different, and Crohn’s symptoms vary from one person to the next. Risk factors for more progressive disease and worse prognosis include younger age at diagnosis, inflammation or disease activity covering a large part of the bowel, stricturing (narrowing) of the bowel, and involvement of the ileum (last part of the small bowel before the large bowel) or rectum. Patients in which only the colon is affected tend to have a better prognosis with less aggressive disease and less need for surgery in the first 10 years of diagnosis. […] Crohn’s disease is associated with an increased risk of colorectal cancer. However, people with Crohn’s usually have the same life expectancy as people without Crohn’s disease.

• #4 Prevalence and predictors of severe Crohn’s disease at a tertiary hospital in South Africa

  https://scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742024000400008

  While both ileocolonic location and penetrating disease at diagnosis of CD have a predictive value for the development of SCD in this study, penetrating disease is a better option. Further research is required to confirm the role of penetrating phenotype as a predictor for the development of SCD. […] In conclusion, the prevalence of SCD in this study was high, and occurred within 1 year of initial diagnosis of CD in most patients. Penetrating disease at diagnosis of CD may be a prognostic marker for SCD at this study setting. However, further research and validation are necessary to establish the clinical utility of this prognostic marker.

• #5 Predicting outcomes for Crohn’s disease using a molecular biomarker: profile trial

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9600841/

  Crohn’s disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel disease (IBD), collectively affect 0.8% of the population in the UK. IBD can have a profound health and socio-economic impact on patients, typically affecting educational achievement, relationships and employment. However, the course of IBD varies substantially between individuals and accurate prognostic markers have historically not been available to guide clinical practice. It has, therefore, become widely recognised that no single treatment strategy would be optimal for all patients. Accordingly, there has been an aspiration for a more personalised approach in IBD, being named one of the key research priorities by a research priority-setting partnership group, which included patients, clinicians and other key stakeholders.

• #6 PRedicting Outcomes For Crohn’s dIsease using a moLecular biomarkEr (PROFILE): protocol for a multicentre, randomised, biomarker-stratified trial

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6286485/

  The course of Crohns disease (CD) varies substantially between individuals, but reliable prognostic markers do not exist. This hinders disease management because patients with aggressive disease are undertreated by conventional step-up therapy (in which treatment is gradually escalated in response to refractory or relapsing disease) while those with more indolent disease would be exposed to unnecessary treatment-related toxicity if a more aggressive top-down approach was indiscriminately used. […] The PROFILE trial will test whether stratification using a whole blood gene expression biomarker can facilitate personalised therapy in CD and improve clinical outcomes. The hypothesis is that the biomarker will identify individuals destined to run an aggressive, relapsing course, and that in these individuals a greater benefit of early top-down therapy will be observed. Similarly, we hypothesise that the biomarker will reliably identify those patients destined to experience more indolent disease, who can be effectively managed using conventional accelerated step-up approaches without the risks and side-effects of unnecessary immunosuppression.

• #7 Serum amyloid A for predicting prognosis in patients with newly diagnosed Crohn’s disease | BMJ Open Gastroenterology

  https://bmjopengastro.bmj.com/content/11/1/e001497

  Serum amyloid A (SAA) was found to be positively correlated with the activity of Crohns disease (CD); however, its prognostic value remains uncertain. […] A 100-unit increment in SAA level generated 14% higher risk for surgery and 12% for disease progression. […] Baseline SAA level 89.2mg/L led to significantly elevated risks for surgery and disease progression. […] Although causality was not found, baseline SAA level was an independent predictor of surgery and disease progression in newly diagnosed CD, and had additive benefit to existing prediction models. […] Higher baseline SAA level was significantly associated with bowel resection, the risk increased linearly with increasing SAA. […] This prognostic association was merely correlational rather than causal. […] SAA has the potential as a CD prognostic biomarker.

• #8 Serum amyloid A for predicting prognosis in patients with newly diagnosed Crohn’s disease | BMJ Open Gastroenterology

  https://bmjopengastro.bmj.com/content/11/1/e001497

  Incorporating SAA into the model with known risk factors significantly improved its prognostic ability. […] Elevated baseline SAA level was an independent risk factor for surgery and disease progression in patients with newly diagnosed CD, and SAA might own significant additive benefit to existing prediction models.

• #9

  https://link.springer.com/article/10.1007/s00384-016-2706-3

  In Crohns disease, prognosis is related to the severity of mucosal inflammation. […] The aim of this study was to investigate whether the presence of LTA predicts the occurrence of complicated disease behaviour in newly diagnosed Crohns disease. […] During the 5-year follow-up, 33.1% of patients in the group with LTA developed complicated disease behaviour compared to 14.6% in patients without LTA (p0.001). […] The presence of LTA was identified as a risk factor for complicated disease behaviour (HR 2.6, 95% confidence interval (CI) 1.54.2,p 0.0001). […] In newly diagnosed Crohns disease, the presence of LTA was an independent risk factor for the development of complicated disease behaviour. […] In this study of 383 newly diagnosed Crohns disease patients, patients with liver test abnormalities more often developed complicated disease behaviour and more often were in need of hospitalization or surgery within 5 years of diagnosis than patients without LTA. […] The presence of LTA was associated with an increased risk of hospitalizations (HR 1.7, p= 0.023) as well as surgery (HR 2.3,p = 0.015). […] The presence of LTA was associated with an increased risk of surgery only in those patients without complicated disease behaviour at diagnosis.

• #10 Predicting outcomes for Crohn’s disease using a molecular biomarker: profile trial

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9600841/

  We have developed, optimised and validated a whole-blood qPCR classifier that predicts disease course from diagnosis in patients with IBD. This classifier is currently being assessed in the PROFILE trial, the first biomarker-stratified trial in gastroenterology and, if clinical utility of a stratified treatment approach is demonstrated, this would represent a major step towards personalised therapy in IBD.

• #11 PRedicting Outcomes For Crohn’s dIsease using a moLecular biomarkEr (PROFILE): protocol for a multicentre, randomised, biomarker-stratified trial

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6286485/

  The PROFILE trial is the first biomarker-stratified trial in IBD and will investigate whether a blood-based biomarker, assessed at diagnosis, can stratify patients with CD to receive therapy that is appropriately matched to their subsequent disease course. If stratification by IBDhi/IBDlo status is demonstrated to improve clinical outcomes by appropriately identifying those patients who require top-down therapy and those who can be safely managed with accelerated step-up therapy, this would represent a step change in the management of CD and would help make personalised medicine a reality for patients.

• #12

  https://journals.lww.com/dcrjournal/fulltext/2021/06000/a_validated_prognostic_model_and_nomogram_to.9.aspx

  Predicting aggressive Crohns disease is crucial for determining therapeutic strategies. […] We aimed to develop a prognostic model to predict complications leading to surgery within 1 year after diagnosis of Crohns disease and to create a nomogram to facilitate clinical decision making. […] The mean follow-up period was 54 months (SD 13 months). Of the 614 eligible patients, 13.5% developed complications leading to surgery. […] Our validated prognostic model effectively predicted early-onset complications leading to surgery and screened aggressive Crohns disease, which will enable physicians to customize therapeutic strategies and monitor disease. […] A validated prognostic model can precisely predict negative outcomes and is the cornerstone in preventive and tailored therapeutics, especially for CD because of its complexity.

• #13

  https://journals.lww.com/dcrjournal/fulltext/2021/06000/a_validated_prognostic_model_and_nomogram_to.9.aspx

  We identified age, extraintestinal manifestations, previous surgery, perianal disease, and disease duration as independent factors associated with complications leading to surgery in patients with CD. We have developed a prognostic model and a nomogram to aid in personalized clinical decision making.

• #14 Prevalence and predictors of severe Crohn’s disease at a tertiary hospital in South Africa

  https://scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742024000400008

  Predicting severe Crohn’s disease (SCD) can assist in planning risk reduction therapy for SCD, thereby improving disease outcomes […] The rate of SCD was 64.5%, with 63.3% of patients developing SCD within 1 year of CD diagnosis. […] Most patients with CD developed SCD within 1 year of their CD diagnosis. CD with a penetrating phenotype at diagnosis is a good predictor for the development of SCD and should be further investigated. […] Additionally, early aggressive treatment may prevent poor outcomes associated with SCD. […] The predictive accuracy of ileocolonic disease location and penetrating disease at diagnosis for subsequent SCD is shown in Table 3. Sensitivity for ileocolonic location was fair (72.7%, 95% CI 59.0 – 83.9%). Sensitivity for penetrating disease was good (85.7%, 95% CI 63.7 – 97.0%).

• #15 Inflammation-driven malnutrition: a new screening tool predicts outcome in Crohn’s disease | British Journal of Nutrition | Cambridge Core

  https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/inflammationdriven-malnutrition-a-new-screening-tool-predicts-outcome-in-crohns-disease/D9B298A08E07B653007FCD60023C900A

  Malnutrition is a frequent feature in Crohns disease (CD), affects patient outcome and must be recognised. […] We aimed to design and evaluate a new screening tool that combines both malnutrition and inflammation parameters that might help predict clinical outcome. […] At 6 months, MIRT significantly predicted outcome in numerous nutritional and clinical parameters (SGA, CD-related flares, hospitalisations and surgeries). […] The newly developed MIRT was found to reliably predict clinical outcome in CD patients. […] The clinical outcome was measured by disease activity (CDAI, HBI), malnutrition (SGA) and the following clinical parameters that occurred during the 6-month study period: days spent in hospital, number of flare-ups diagnosed by a senior physician, number of complications (new stenosis, fistula or abscess), number of CD-related surgeries and changes in drug treatment. […] MIRT predicted clinical outcome in CD patients at 6 months.

• #16 Establishment and internal validation of a model to predict the efficacy of Adalimumab in Crohn’s disease | Scientific Reports

  https://www.nature.com/articles/s41598-024-82855-0

  Background: Clinically, the ability to distinguish which Crohns disease patients can benefit from Adalimumab is limited. […] A predictive model was constructed by multivariate logistic regression (Adalimumab-positive cell count (OR, 1.143; 95%CI, 1.0561.261), disease duration (OR, 0.967; 95%CI, 0.9370.986), and neutrophil count (109/L) (OR, 1.274; 95%CI,1.0141.734)). […] This model provides a convenient tool to assess the likelihood of patient remission prior to Adalimumab treatment, thereby supporting the development of personalized treatment plans. […] The predictive model yielded an area under the curve of 0.866 (95%CI, 0.7760.956), and in the internal validation, the area under the curve was 0.870 (95%CI, 0.7700.940). […] Therefore, we further investigated the clinical significance of each variable. For disease duration, some studies have concluded that the shorter the disease duration assessed, the better the response to early treatment in CD patients.

• #17 Establishment and internal validation of a model to predict the efficacy of Adalimumab in Crohn’s disease | Scientific Reports

  https://www.nature.com/articles/s41598-024-82855-0

  Collectively, our study found CD patients with high neutrophil count before ADA treatment, but the exact reason has not yet been reported. […] In conclusion, the ADA-positive cell count obtained in vitro by immunofluorescence technique predicts the clinical efficacy of ADA treatment of CD patients for 12 weeks. Then, a nomogram was built to predict clinical remission probability at 12 weeks among CD patients. This nomogram incorporated three variables: ADA-positive cell count, disease duration, and neutrophil count. The nomogram showed good discriminatory ability, calibration, and clinical validity, providing an ideal method to predict ADA effectiveness and suggest anti-TNF therapy selection in advance.

• #18 European Crohn´s and Colitis Organisation – ECCO – P388 Prediction model to safely CEASE anti-TNF therapy in Crohn’s disease: validation of a predictive diagnostic tool for the cessation of anti-TNF treatment in CD in a Dutch population

  https://www.ecco-ibd.eu/publications/congress-abstracts/item/p388-prediction-model-to-safely-cease-anti-tnf-therapy-in-crohn-8217-s-disease-validation-of-a-predictive-diagnostic-tool-for-the-cessation-of-anti-tnf-treatment-in-cd-in-a-dutch-population.html

  Tools for patient identification to safely cease anti-TNF therapy in Crohns disease (CD) patients are urgently needed. […] A previously developed predictive diagnostic tool to safely cease anti-TNF therapy in CD has been validated, however, showed moderate performance in this external cohort. A further update of the model with biochemical and histological data is necessary to improve our ability to adequately select patients for cessation of anti-TNF therapy and is currently being performed.

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