成人和儿童克罗恩病并发症的预测因素:来自 epi-IIRN 的全国性研究。

IF 4.5 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Ohad Atia, Rona Lujan, Rachel Buchuk, Shira Greenfeld, Revital Kariv, Yiska Loewenberg Weisband, Natan Ledderman, Eran Matz, Oren Ledder, Eran Zittan, Henit Yanai, Doron Shwartz, Iris Dotan, Daniel Nevo, Dan Turner
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引用次数: 0

摘要

背景:由于从未曾选定的人群中获得的有关复杂克罗恩病(CD)预测因素的数据很少,因此我们旨在利用一个大型全国性队列--epi-IIRN--来探索儿童和成人 CD 患者的病程预测因素:方法:我们从以色列的 4 家健康维护组织获取了 CD 患者的数据,这些组织的记录覆盖了 98% 的人口(2005-2020 年)。从时间到事件模拟了复杂病程,即与 CD 相关的手术、类固醇依赖或需要>1 类生物制剂。分层聚类根据现有的实验室结果对诊断时的疾病严重程度进行分类:共纳入16 659例患者(其中2999例[18%]为儿童发病),随访121 695人年;3761例(23%)病程复杂(750例[4.5%]转用第二类生物制剂,1547例[9.3%]类固醇依赖,1463例[8.8%]CD相关手术)。并发症在儿童发病中比成人发病中更为常见(26% vs 22%,几率比1.3;95%置信区间[CI],1.2-1.4)。在 Cox 多变量模型中,使用生物制剂进行诱导治疗(危险比 [HR],2.1;95% 置信区间 [CI],1.2-3.6)和诊断时实验室检测的严重程度(HR,1.7;95% 置信区间 [CI],1.2-2.2)可预测疾病复杂化,而高社会经济地位则具有保护作用(HR,0.94;95% 置信区间 [CI],0.91-0.96)。在儿童中,实验室检查可预测病程(HR,1.8;95% CI,1.2-2.5),营养不良也可预测病程(中位体重指数 Z 评分-0.41;95% CI,-1.42 至 0.43(病情复杂 vs -0.24;95% CI,-1.23 至 0.63));P 结论:在这一全国性队列中,儿童的营养不良程度可预测病程(HR,1.8;95% CI,1.2-2.5):在这一全国性队列中,四分之一的 CD 患者病程复杂,除了儿童营养不良外,实验室检查、诱导治疗类型、社会经济状况也可预测病程复杂。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors of Complicated Disease Course in Adults and Children With Crohn's Disease: A Nationwide Study from the epi-IIRN.

Background: Since data on predictors of complicated Crohn's disease (CD) from unselected populations are scarce, we aimed to utilize a large nationwide cohort, the epi-IIRN, to explore predictors of disease course in children and adults with CD.

Methods: Data of patients with CD were retrieved from Israel's 4 health maintenance organizations, whose records cover 98% of the population (2005-2020). Time-to-event modeled a complicated disease course, defined as CD-related surgery, steroid-dependency, or the need for >1 class of biologics. Hierarchical clustering categorized disease severity at diagnosis based on available laboratory results.

Results: A total of 16 659 patients (2999 [18%] pediatric-onset) with 121 695 person-years of follow-up were included; 3761 (23%) had a complicated course (750 [4.5%] switched to a second biologic class, 1547 [9.3%] steroid-dependency, 1463 [8.8%] CD-related surgery). Complicated disease was more common in pediatric- than adult-onset disease (26% vs 22%, odds ratio, 1.3; 95% confidence interval [CI], 1.2-1.4). In a Cox multivariate model, complicated disease was predicted by induction therapy with biologics (hazard ratio [HR], 2.1; 95% CI, 1.2-3.6) and severity of laboratory tests at diagnosis (HR, 1.7; 95% CI, 1.2-2.2), while high socioeconomic status was protective (HR, 0.94; 95% CI, 0.91-0.96). In children, laboratory tests predicted disease course (HR, 1.8; 95% CI, 1.2-2.5), as well as malnutrition (median BMI Z score -0.41; 95% CI, -1.42 to 0.43 in complicated disease vs -0.24; 95% CI, -1.23 to 0.63] in favorable disease; P < .001).

Conclusions: In this nationwide cohort, CD course was complicated in one-fourth of patients, predicted by laboratory tests, type of induction therapy, socioeconomic status, in addition to malnutrition in children.

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来源期刊
Inflammatory Bowel Diseases
Inflammatory Bowel Diseases 医学-胃肠肝病学
CiteScore
9.70
自引率
6.10%
发文量
462
审稿时长
1 months
期刊介绍: Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.
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