P283 Predicting outcomes in paediatric Crohn’s disease: A systematic review
Notice bibliographique
Résumé
Crohn’s disease (CD) developing during childhood and adolescence encompasses a spectrum of phenotypes and disease severity. Risk stratification to facilitate early, more individualised therapy is key to optimizing outcomes. We aimed to systematically review the evidence pertaining to prediction of chronically active inflammatory activity and disease complications in paediatric CD. We searched Pubmed and EMBASE from 1992 to 2017 for observational or controlled, English language studies reporting longitudinal associations between patient/disease characteristics and chronically active inflammatory disease or the following CD complications: B2/B3/perianal disease, linear growth impairment, bone disease, surgery, response to therapy and disease extension. Study selection was performed by two reviewers. Risk of bias was assessed with the Newcastle-Ottawa tool. The search identified 97 eligible studies (all observational). The majority focused on associations with surgery (n = 46), internal stricturing (B2) (n = 32) or penetrating (B3) (n = 30) complications; fewer on growth impairment (n = 20) or perianal fistulising disease (n = 19); and very few on chronically active inflammatory disease (n = 9) or bone disease (n = 10). In a large (n = 913) prospective study, older age and non-Caucasian ethnicity were associated with adjusted hazard ratios (aHRs) of 1.4 (95% confidence interval (CI) 1.2–1.8) and 3.2 (1.4–7.3), respectively, for B3 complications. Across several studies, ASCA IgG was associated with aHRs of 2.7 to 2.8 for B3 disease and CBir1 with aHRs of 2.3 to 3.0 for B2 and/or B3 disease. In a single large study, the aHR of OmpC for B2 and/or B3 disease was 2.4 (1.2–4.9). Across several studies, male sex was associated with HRs of 3.6 to 3.9 for linear growth impairment. Lower weight and BMI, and more active disease were associated with lower bone mineral density over time. Table 1 lists factors for which at least one study reported an association with an outcome of interest. The number of studies demonstrating a positive association, amongst all studies examining the predictor, is shown in brackets. No clear risk factors were identified for chronically active inflammatory disease. Factors with at least 1 study demonstrating an association with an outcome of interest (numbers in brackets indicate the number of studies showing an association amongst all studies examining that factor). Factors with at least 1 study demonstrating an association with an outcome of interest (numbers in brackets indicate the number of studies showing an association amongst all studies examining that factor). The majority of identified predictors are observed demographic or phenotypic associations. To date, only antimicrobial serology provides additional guidance for individualising treatment based on risk prediction. Molecular predictors of chronically active inflammatory disease and biologic treatment responsiveness are badly needed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,030 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,009 | 0,009 |
| Bibliométrie | 0,007 | 0,010 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».