bluuebunny/crossref_metadata_2025_split huggingface dataset:
P402 Early diagnosis of Crohn’s disease with perianal lesions as first clinical symptom: Development and validation of a new MR imaging-based model disease
Authors: Xiang Y , Yang F , Yuan F , Zhang J , Qiao L , Zhu Z , Chen Q , Gong Y , Yang B 
Published: January 2024

Abstract

Background
Early diagnosis is crucial for the treatment and prognosis of Crohn's disease. Perianal fistulae or abscesses may present as the initial manifestation of Crohn's disease (CD) in patients. Despite magnetic resonance imaging (MRI) is the gold standard for the clinical assessment of perianal fistulae, there is shortage of MRI properties for clinical use in early perianal fistula diagnosis in CD.

Methods
Data from patients with a definitive diagnosis of PFCD and cryptoglandular disease (CGD) between September 2013 and December 2020 were examined retrospectively. The data was splited into training and test sets at a 7:3 ratio. The MRI characteristics were reviewed by two gastroenterology radiologists in consensus. The characteristics were then used to train a random forest classification model to predict a diagnosis of PFCD. The validity of the model was assessed using the area under the receiver operating characteristic curve (AUROC) and confusion matrix. Predictor importance was determined using the Shapley additive explanation (SHAP) framework.

Results
A total of 144 patients diagnosed with PFCD and 406 patients diagnosed with CGD were included. Utilizing the Boruta algorithm, 12 significant features which confirmed important for the diagnosis of PFCD, and a random forest classification model was developed. The model demonstrated an area under the receiver operating characteristic curve (AUROC) of 0.9294 (95% CI: 0.8706-0.9882), an accuracy of 0.9515 (95% CI: 0.9067-0.9788) and a kappa of 0.8779. SHAP values was utilized to estimate the variable importance, and the top five features were ulceration in rectal wall, thickened rectal wall, T2 hyperintensity, submucosal fistula and age. The model for predicting PFCD diagnosis based on MRI was dynamically visualised using a web display approach (https://doctoryang1971.shinyapps.io/forceplot/).

Conclusion
We have developed a multi-modal visual dynamic prediction model that can be effectively used to guide the early diagnosis of patients with Crohn's disease who present with perianal fistula at their first clinical visit. PFCD is likely to originate as transmural ulcers leading to submucosal inflammation or fistulae before penetrating the anal sphincter and developing into complex perianal fistulae.
P409 Optimal endoscopic healing thresholds defined by MM-SES-CD &lt; 22.5 and SES-CD &lt; 4 are associated with low risk of disease progression in Crohn’s disease
Authors: Narula N , Wong E C , Dulai P S , Patel J , Marshall J K , Yzet C , Jairath V , Ungaro R C , Colombel J F , Reinisch W ,   CALM LTE
Published: January 2024

Abstract

Background
After initiation of therapy in Crohn's disease (CD), it remains unclear what the optimal endoscopic healing (EH) threshold to target is using the SES-CD and the MM-SES-CD (Modified Multiplier Simple Endoscopic Score for Crohn’s disease). We assessed MM-SES-CD and SES-CD thresholds that are best associated with low likelihood of long-term disease progression.

Methods
Week 48 endoscopy videos from patients with CD who participated in the CALM long-term extension LTE study were obtained and re-read by central readers to obtain a SES-CD and MM-SES-CD score, which was used for the derivation cohort. A real-world validation was performed with data from 99 patients that had clinical response using a mixed cohort of biologic therapies from the McMaster IBD database. The primary outcome was disease progression, defined as a new internal fistula/abscess, stricture, perianal fistula or abscess, CD-related hospitalization or surgery since the end of the CALM trial for the derivation cohort, and over the observed period of follow-up for the validation cohort. The maximum Youden index was calculated to determine the optimal MM-SES-CD and SES-CD thresholds. Receiver operating characteristic curve analyses compared threshold scores of various remission definitions on disease progression. Kaplan-Meier survival curve analyses were performed to compare the time to disease progression from the end of study endoscopy in the derivation cohort.

Results
In the derivation cohort, the optimal thresholds associated with a low likelihood of disease progression were MM-SES-CD &lt;22.5 and SES-CD &lt;4. A significantly greater proportion of patients with a MM-SES-CD ≥22.5 had disease progression as compared to patients with MM-SES-CD &lt;22.5 [10/17 (58.8%) vs. 3/44 (6.8%), p&lt;0.001]. Similarly, a significantly greater number of patients with a SES-CD ≥ 4 had disease progression compared to those with a SES-CD &lt;4 [11/25 (44.0%) vs. 2/36 (5.6%), p&lt;0.001]. Compared to other clinical or endoscopic remission definitions, obtaining a MM-SES-CD &lt;22.5 at the end of the CALM study performed the best for predicting disease progression [AUC: 0.81 (95% CI: 0.68-0.94), p&lt;0.001](sensitivity 76.9% (95% CI: 46.2-95.0), specificity 85.4% (95% CI: 72.2-93.9)). Compared to those with lower scores, patients with MM-SES-CD ≥ 22.5 (log-rank p&lt;0.0001) and SES-CD ≥ 4 (log-rank p=0.0002) had a significantly greater probability of disease progression (Figure 1A/B). These findings were confirmed in the validation cohort (Figure 1C/D).

Conclusion
Achievement of MM-SES-CD &lt;22.5 and SES-CD &lt;4 was associated with low risk of CD progression and may be a suitable target for EH in clinical trials and practice. Our findings support that targeting EH may modify the natural course of CD.
P426 Hematological Composite Scores in Patients with Inflammatory Bowel Disease
Authors: Morant-Domínguez A , Vera-Santana B , Hernández-Camba A , Ramos L , Alonso-Abreu I , Hernández Álvarez-Buylla N , Vela M , Hernández-Guerra M , Laura A , Ferraz-Amaro I , Carrillo Palau M 
Published: January 2024

Abstract

Background
Ulcerative colitis (CU) and Crohn’s disease (CD) are described as inflammatory bowel diseases (IBD). Emerging as potential blood-based inflammatory biomarkers in various chronic diseases are the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SIRI, calculated as neutrophils × monocytes/lymphocytes). In this work we aim to analyze if these hematological composite scores differ between IBD patients and healthy controls, and whether they are related to disease activity.

Methods
A total of 197 IBD patients, 130 with CD and 67 with CU, and 208 age- and sex-matched healthy controls were recruited. NLR, MLR, PLR, and SIRI were calculated. Multivariable linear regression analysis was performed to study whether these scores differ between patients and controls and how they related to IBD activity scores.

Results
After multivariable analysis adjustment, NLR and PLR, but not SIRI and MLR, were significantly higher in IBD patients compared to controls (table 1). C-reactive protein and SIRI and NLR correlated in patients with IBD. Nevertheless, fecal calprotectin was not related to none of these blood scores. Besides, disease activity parameters were not associated with any of the composite blood-based scores in both patients with CD and CU.

Conclusion
NLR and PLR, independently, are heightened in IBD patients in contrast to controls. However, SIRI and MLR do not share this distinction. Surprisingly, none of the four hematological scores displayed correlations with disease activity in either CD or UC patients.
Table 1. Multivariable analysis of the differences between patients and controls in hematological count cells and scores
P437 Feasibility study of a Point-of-Care assay for rapid determination of anti-TNFα biologics in capillary blood
Authors: Ricken B , Brosi L , Reinhard C , Anchling L , Neu S , Afonso J , Schuster T , Wütherich E , Burri E , Paul S , Berger A E , Guirao W , Barrau M , Bastide L , Roblin X , Pflimlin-Fritschy V , Rutscher U , Hrúz P , Gerhold C B 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) patients benefit from therapeutic drug monitoring and personalized adjustment of anti-TNFα drugs such as adalimumab (ADL) and infliximab (IFX). Commercially available rapid assays allow the fast and easy measurement of ADL and IFX. Unfortunately, most ADL and IFX in-vitro diagnostic assays rely on serum as analyte matrix. This is a critical hurdle in point-of-care (POC) analysis, as it requires laboratory professionals, additional laboratory instruments and is time consuming. Therefore, two recently developed rapid tests for the determination of ADL and IFX that only require capillary blood (CB) or EDTA whole blood (WB) without further treatment are tested in a POC setup at three different study sites. The primary aim of this study is to demonstrate matrix equivalency of CB and EDTA WB compared to serum as reference.

Methods
This observational study was performed at three sites. Two sites in Switzerland, Clarunis Basel and Kantonsspital Baselland, and one site in France, Centre Hospitalier Universitaire de Saint-Étienne. Sample analysis was performed by healthcare professionals at the study sites with the established Quantum Blue® serum rapid tests and the newly developed capillary blood applications. Blood samples from patients under infliximab therapy were collected directly before infusion (trough level of drug). Samples from adalimumab-treated patients were collected irrespective of the injection schedule. In total, up to 100 IBD patients are anticipated in the study, 50 under infliximab therapy and 50 treated with adalimumab. This work evaluated the interim outcome after the analysis of 29 ADL and 18 IFX patients.

Results
Bland-Altmann analysis revealed a good agreement of CB and EDTA WB compared to serum for both IFX and ADL sample sets. The mean bias for the biologic’s trough level analysed in CB and compared to serum was 5.2% for IFX and -11.7% for ADL. Passing-Bablok analysis for CB versus serum resulted in a slope of 0.92 and an intercept at 0.08 for IFX and a slope of 0.86 and an intercept at -0.063 for ADL. A comparison of EDTA WB compared to serum revealed a mean bias of 7.8% for IFX and 7.4% for ADL. Passing-Bablok analysis for EDTA WB versus serum resulted in a slope of 1.00 and an intercept at 0.00 for IFX and a slope of 1.00 and an intercept at 0.30 for ADL.

Conclusion
The newly developed rapid Quantum Blue® assays for the determination of infliximab and adalimumab in capillary blood and EDTA whole blood are very well comparable to the analysis of either biologic in serum. This study furthermore demonstrated the assays are well suited to be used in a POC setting, such as infusion centres, rather than in a laboratory. Both assays are standardized to WHO reference material.
P453 Surveillance for colorectal dysplasia and neoplasia in Latin American patients with Ulcerative Colitis
Authors: Parra Izquierdo L V , Frías-Ordoñez J , Gil F L , Puentes-Manosalva F , Suarez K E , Villa-Ovalles K , Paredes J , Jara M L , Andrade D , Ibañez E , Florez-Sarmiento C 
Published: January 2024

Abstract

Background
colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) has worse prognostic features and a higher mortality rate compared to sporadic CRC. Screening colonoscopy is therefore an important tool to consider in this population. The aim of this study is to describe the findings of endoscopic surveillance of CRC in patients with IBD using the technology available in Latin American countries.

Methods
Descriptive, multicentre, cross-sectional, descriptive study conducted in multiple Latin American countries in patients with ulcerative colitis (UC) more than 8 years after diagnosis and ulcerative colitis with primary sclerosing cholangitis regardless of the time of diagnosis of colitis. Surveillance colonoscopies were performed according to the availability of technology in each country.

Results
78 subjects, 50% women, from 5 countries (Colombia, Costa Rica, Peru, Ecuador, and Dominican Republic), with mean age 47.9 (range 20.01-89.71; SD 151.4) years, mean age at disease diagnosis of 34.7 (range 8.52-80.9; SD 14.08) years, and mean time of disease of 12.8 (range 4.6-56.8; SD 8.9) years. 57.7% (45/78) with extensive colitis, 8.9% (7/78) with a family history of colorectal cancer. 52.6% (41/78) on biologic therapy. 24.4% (19/78) current use of Azathioprine. 9% (7/78) of corticosteroids. 70.5% (55/78) oral mesalazine. In 5.1% it was used white light, 1.3% high resolution white light, 76.9% digital chromoendoscopy and 16.7% chromoendoscopy with staining. In those with digital chromoendoscopy, NBI was used in 38.3% (28/73), 37% (27/73) LCI/BLI, and 24.6% (14/73) I-Scan. It was found pseudopolyps in 50% (39/78), and 11.5% (9/78) stenosis. 7.7% (6/78) had a history of previous dysplasia. Regarding the Paris classification modified by SCENIC consensus, 28.2% (22/78) found 0-I lesions, 16 subjects were 0-I s, and 6 subjects 0-Ip. 5 subjects had 0-II lesions, of which 4 subjects in 0-IIa, and 1 in 0-IIc. 1 subject had lesion type 0-III. 1 subject had mixed lesions (0-IIa+0-IIc), 6.4% (5/78) lesion with ulceration, 10.2% (8/78) with disruption of lesion borders, with KUDO classification, Kudo III, 5.1 (4/78) Kudo IV and 3.8% (3/78) Kudo V. Endoscopic resectability was possible in all lesions. Histological findings were: (11/78) low grade dysplasia, (1/78) high grade dysplasia and (3/78) adenocarcinoma. As for the presence of dysplasia not visible in white light in random biopsies, it was only detected in (2/78).

Conclusion
in this first Latin American study, endoscopic techniques with digital chromoendoscopy with targeted biopsies were preferred, most were endoscopically visible and resectable lesions suggesting that the yield of targeted biopsies is superior to random biopsies.
P460 The POCER index: application of a novel endoscopic score in a real-life cohort of patients with Crohn's disease after surgery
Authors: Parisio L , Del Gaudio A , Privitera G , Cuccia G , Lopetuso L R , Laterza L , Rumi G , De Biasio F , Mignini I , Calvez V , Coppola G , Gasbarrini A , Scaldaferri F , Pugliese D 
Published: January 2024

Abstract

Background
The Rutgeerts score (Rs) is the most widely used score that offers essential prognostic information in the field of postoperative management of patients (pts) with Crohn's disease (CD). A recent study has introduced the POCER postoperative index (Pi), which includes the circumferential extent and depth of anastomotic ulcers, which can be an additional tool to better define the prognosis of this category of pts

Methods
Our study aims to evaluate the Pi in a real-life cohort, its correlation with Rs, and its prognostic value. We conducted a single center retrospective study, evaluating different outcomes of pts with CD who underwent ileocolonic resection. All pts underwent the first endoscopic evaluation within 6-12 months to assess postoperative recurrence (POR). We applied both the Rs and the Pi. POR was defined as Rs≥2 or Pi≥2. A clinical and objective assessment was performed at 18-24 months. Clinical Recurrence (CR), evaluated in all pts, was defined with a Harvey-Bradshaw Index (HBI)≥5. Objective Recurrence (OR), evaluated in a subgroup, was defined by the presence of endoscopic activity and/or radiological activity (assessed by ultrasound (US) when a wall thickness≥4 mm was present)

Results
We included 103 pts who underwent ileocolonic resection, with a median age at surgery of 38 years old. The main indication for surgery was a stenotic disease. 63% of pts had ≥1 risk factor for POR. All pts underwent prophylactic biologic therapy. At 6 month, POR was observed in 50 (48.3%) and 17 (16.5%) pts, according to Rs and Pi, respectively. Mean Rs and Pi were 1.39 (± 1.31) and 0.70 (± 1.08); a moderate correlation (r=0.523) between the two was observed. We assessed the ability of Rs and Pi at 6-12 months to predict CR and OR at 18-24 months. A Rs≥2 predicted CR with an AUROC of 0.8345 (sensitivity 93.3% and specificity 59.3%). A Pi≥2 predicted CR with an AUROC of 0.693 (sensitivity 33.33% and specificity 84.88%). When evaluating the performance of the mean of the two scores, we observed that a mean score≥1.75 could predict CR with an AUROC of 0.807 (sensitivity 80.00% and specificity 68.6%). A mean score≥1.75 could also predict OR with an AUROC of 0.662 (sensitivity 45.45% and specificity 74.29%). We also evaluated the subgroup of pts with Rs 1-2 at 6 months and the significance of the addition of the Pi: although no statistical significance was observed, a Pi&lt;1 had a specificity of 100% in predicting the absence of CR

Conclusion
Rs and Pi can be used to assess POR and predict CR and OR. The combination of the two might outperform each of them with a good compromise between sensitivity and specificity. The addition of the Pi in pts with Rs 1-2, might be helpful in clarifying the prognostic significance of this result
P475 Potential of molecular remission: tissue neutrophil elastase is better than histological activity for predicting long-term relapse in patients with Ulcerative Colitis in endoscopic remission
Authors: Jun Y K , Lee J A , Choi Y , Shin C M , Park Y S , Kim N , Lee D H , Oh H J , Yoon H 
Published: January 2024

Abstract

Background
Growing interest exists in deep remission, beyond clinical and endoscopic remission, to enhance long-term prognosis in patients with ulcerative colitis (UC). Our study aimed to evaluate the risk of relapse according to tissue expression levels of calprotectin and neutrophil elastase (NE) in patients with quiescent UC.

Methods
Rectal biopsies were performed on 218 patients with UC in clinical and endoscopic remission. Histological activity was prospectively scored using the Robarts Histological Index. Tissue calprotectin and NE levels were evaluated using immunohistochemistry. Clinical relapse was defined as the requirement for medical therapy escalation, systemic steroid administration, UC-related emergency room visits, hospitalization, or surgery. Optimal tissue calprotectin and NE cutoffs for relapse were determined using log-rank analysis. A Kaplan–Meier analysis was performed to assess the cumulative incidence of clinical relapse, and a Cox proportional hazard analysis was conducted to identify the risk factors for clinical relapse.

Results
Tissue calprotectin and NE levels were significantly higher in patients with histological activity than in those in histological remission (P &lt; 0.001, respectively). The optimal cutoffs of tissue calprotectin and NE for relapse were 10.61 /mm2 and 22.08 /mm2, respectively. The 3-year clinical relapse risk was significantly lower in the low tissue NE group than in the high tissue NE group (P = 0.009); however, it did not differ between the low- and high-tissue calprotectin group (P = 0.094) (Figure). In multivariate analyses, a low level of tissue NE expression (adjusted hazard ratio [aHR] = 0.453, 95% confidence interval [CI] = 0.225–0.911, P = 0.026) and maintenance treatment using biologics (aHR = 0.368, 95% CI = 0.141–0.962) were independently associated with a lower risk of 3-year clinical relapse, but previous steroid exposure was independently related to increase the risk of 3-year clinical relapse (aHR = 2.824, 95% CI = 1.298–6.141) (Table). The histological index and tissue calprotectin did not have influence on the 3-year clinical relapse.

Conclusion
In patients with UC who have achieved clinical and endoscopic remission, tissue expression of NE is a better predictor of long-term relapse than histological activity.
P488 Development and validation of a risk prediction tool for inflammatory bowel disease (IBD) diagnosis in patients presenting in primary care with abdominal symptoms, a UK based study
Authors: Umar N , Wambua S , Harvey P , Haroon S , Adderley N J , Trudgill N 
Published: January 2024

Abstract

Background
There are no prediction models for a diagnosis of inflammatory bowel disease (IBD) in primary care. An IBD risk prediction tool has the potential to reduce the length of time patients have undiagnosed IBD symptoms and improve IBD clinical outcomes. Therefore, our aim was to develop and validate a risk prediction model for the diagnosis of IBD, ulcerative colitis (UC) and Crohn’s disease (CD) in men and women separately.

Methods
A population-based retrospective open cohort study using Clinical Practice Research Datalink (CPRD) Aurum database was undertaken between 1st January 2010 and 31st December 2019, including patients aged 18 years or older. Patients were followed from first presentation with lower gastrointestinal (GI) symptoms potentially related to IBD to the earliest of IBD diagnosis, loss to follow-up, death or study end. 2,054,530 patients were in the model derivation cohort and 673,320 patients in the validation cohort. Cox proportional hazards models were used to derive separate risk equations in men and women for IBD, UC and CD. Candidate predictors included demographic factors (age, sex, smoking, body mass index, Charlson comorbidity score, loperamide use), family history of IBD, co-existing conditions (anxiety, depression, irritable bowel syndrome (IBS), haemorrhoids), extraintestinal manifestations (EIM) (mouth ulcers, ophthalmic, primary sclerosing cholangitis, dermatological), investigations (hemoglobin, mean corpuscular volume, platelets, albumin, vitamin B12, ferritin, C-reactive protein, erythrocyte sedimentation rate, calprotectin level). Measures of calibration and discrimination (C-statistic and D-statistic, higher values indicate better discrimination) were determined in men and women separately in the validation cohort at 1,2,3 and 5 years after symptom presentation.

Results
In the derivation cohort, 15,105 (0.7%) patients had an IBD diagnosis (10.014 UC (66.3%) and 5,088 CD (33.7%)). The IBD prediction model included 41 and 40 predictors, and the UC model 37 and 36 predictors, in women and men respectively; the CD model included 37 predictors in both men and women. C-statistics and D-statistics in men were as follows: IBD model 0.77 and 1.74; UC model: 0.81 and 1.95; and CD model: 0.77 and 1.95, respectively. Similar values were observed in women.The measures of discrimination showed that the prediction models reliably differentiated patients with and without IBD, UC and CD in both sexes. Model calibration was good, tending to overestimate at higher risk thresholds in validation cohort.

Conclusion
A risk model of patient demographics, symptoms and investigations performs well for IBD, UC and CD and may help in prioritising suspected IBD referrals in symptomatic subjects in primary care.