Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2025; 17(2): 100665
Published online Feb 16, 2025. doi: 10.4253/wjge.v17.i2.100665
Development and validation of a predictive model for endoscopic improvement of Crohn's disease
Hua-Gang Wang, Cang-La Nima, Qi Zhou
Hua-Gang Wang, Cang-La Nima, Qi Zhou, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Co-first authors: Hua-Gang Wang and Cang-La Nima.
Author contributions: Wang HG and Nima CL contributed equally to this study as co-first authors; Wang HG and Nima CL designed the study, collected and analyzed the data, and drafted the manuscript; Zhou Q designed and revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (Approval No. TJ-IRB202409069).
Informed consent statement: This study only analyzed the data and was exempted from informed consent from the patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and analyzed in the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi Zhou, MD, PhD, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, Hubei Province, China. m202276431@hust.edu.cn
Received: August 23, 2024
Revised: December 12, 2024
Accepted: January 11, 2025
Published online: February 16, 2025
Processing time: 174 Days and 16.1 Hours
Abstract
BACKGROUND

At present, there is a lack of non-invasive indicators to evaluate the changes in endoscopic activity between two visits for patients with Crohn's disease (CD).

AIM

To develop a model for predicting whether endoscopic activity will improve in CD patients.

METHODS

This is a single-center retrospective study that included patients diagnosed with CD from January 2014 to December 2022. The patients were randomly divided into a modeling group (70%) and an internal validation group (30%), with an external validation group from January 2023 to March 2024. Univariate and binary logistic regression analyses were conducted to identify independent risk factors, which were used to construct a nomogram model. The model's performance was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). Additionally, further sensitivity analyses were performed.

RESULTS

One hundred seventy patients were included in the training group, while 64 were included in the external validation group. A binary logistic stepwise regression analysis revealed that the changes in the amplitudes of albumin (ALB) and fibrinogen (FIB) were independent risk factors for endoscopic improvement. A nomogram model was developed based on these risk factors. The area under the curve of the model for the training group, internal validation group, and external validation group were 0.802, 0.788, and 0.787, respectively. The average absolute errors of the calibration curves were 0.011, 0.016, and 0.018, respectively. DCA indicated that the model performs well in clinical practice. Additionally, sensitivity analysis demonstrated that the model has strong robustness and applicability.

CONCLUSION

Our study shows that changes in the amplitudes of ALB and FIB are effective predictors of endoscopic improvement in patients with CD during follow-up visits compared to their previous ones.

Keywords: Crohn’s disease; Endoscopic improvement; Prediction model; Albumin; Fibrinogen

Core Tip: Endoscopic activity assessment is crucial for Crohn's disease (CD) patients. However, most current studies use serological indicators at the time of their visit to predict their current endoscopic activity, while doctors focus more on whether the patient's condition has improved compared to the previous visit. This study aimed to establish a clinical prediction model for evaluating the changes in endoscopic activity during follow-up visits. The final results indicate that the combined changes in albumin and fibrinogen between two visits can effectively predict whether the endoscopic activity of patients with CD will improve during follow-up visits.