P005 A multi-marker serum test to assess the presence of ulcerations in infliximab treated patients with Crohn’s disease
Bibliographic record
Abstract
Resolution of ulcerations is an important component of mucosal healing (MH) in Crohn’s disease (CD) that is typically assessed with ileocolonoscopy, although this is an invasive, expensive and uncomfortable procedure. A non-invasive and accurate multi-marker serum test yielding a mucosal healing index (MHI) score in CD patients has recently been developed and validated based on the CD endoscopic index of severity. The aim of this study was to assess the clinical utility of the multi-analyte MH algorithm in two independent real-life cohorts of CD patients under infliximab (IFX). In cohort 1 (n = 104, median age 36.5 years, 58% female, 11% ileal disease, 25% colonic disease, 64% ileocolonic disease), cross-sectional serum samples were obtained after a median of 32 weeks post-IFX. In cohort 2 (n = 65, median age 36.1 years, 58% female, 11% ileal disease, 20% colonic disease, 69% ileocolonic disease), consecutive serum samples were taken within 20 days before start of IFX and after a median of 23 weeks post-IFX. All serum samples were taken within 30 days of ileocolonoscopy. At time of ileocolonoscopy, complete MH, partial MH and no MH were defined as absence of ulcerations, ≥50% endoscopic improvement but with ulcerations still present, and no endoscopic improvement, respectively. The MH index (MHI) was constructed based on 13 markers and ranged from 0–100. Non-parametric tests were performed and the established cut-offs of MHI ≤ 40 (low endoscopic disease activity) and MHI ≥ 41 (medium to high endoscopic disease activity) were used. p-values of <0.05 were considered significant. In cohort 1, 42.3% of the patients had no MH, 18.3% had partial MH and 39.4% had complete MH after IFX. MHI scores were significantly lower in patients with complete MH compared with patients with partial (p = 0.049) and no (p < 0.001) MH who still had ulcerations post-IFX. Moreover, 78% of patients with MHI scores ≥41 had ulcerations post-IFX. In cohort 2, 34% of the patients had no MH, 32% had partial MH and 34% had complete MH post-IFX. No significant differences in MHI scores were found at baseline, whereas MHI scores were significantly lower in patients with complete MH compared with patients without MH post-IFX (p = 0.009). 88% of patients with MHI scores ≥41 had persistent ulcerations post-IFX. The MHI decreased in 85% of the patients post-IFX, but in 80% of the patients with an increased MHI persistent ulcerations were observed. We validated the clinical utility of the MHI for the assessment of ulcerations in CD patients in two independent real-life cohorts. This novel non-invasive test will be a useful tool to monitor MH in CD patients and help avoid unnecessary repetitive endoscopic evaluations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".