DOP56 Long-term disease progression and resective surgery rates in Crohn’s disease over different therapeutic eras – a population-based study from western Hungary between 1977–2020, data from the Veszprem county cohort
Bibliographic record
Abstract
Abstract Background Few population-based studies have investigated the long-term surgery rates of Crohn’s disease (CD). The present study is a continuation of the Veszprem IBD population based cohort with a follow-up since 1977. Our aim was to analyze the long-term disease course and surgery rates over different therapeutic eras in a prospective population-based database from Veszprem Province, including incident CD patients. Methods Patient inclusion was between January 1, 1977 and December 31, 2018; follow-up ended December 31, 2020. Both in-hospital and outpatient records were collected and comprehensively reviewed at diagnosis and during clinical follow-up. Surgery rates were examined in three different eras based on time of diagnosis: cohort-A, 1977-1995; cohort-B, 1996-2008; and cohort-C, 2009-2018. Results Data of 946 incident CD patients were analyzed (male/female: 496/450; median age at diagnosis:28 years(y) [IQR: 22-40]), with a median of 15y(IQR 9-21) follow-up.Table 1. Overall immunosuppressive therapy use was increasing by time (48.0%/62.4%/65.5%), as well as the probability of biological therapy initiation within 5 years of diagnosis (0.0±0%/7.3±1.2%/22.7±2.2%) in cohorts A/B/C. Figure 1. The cumulative probability of disease behavior progression in patients with luminal (B1) behavior into stenosing or penetrating phenotype (B2/B3) was 27.1±5.3%/ 21.5±2.5%/ 11.3±2.2% in cohorts A/B/C after 5 years (pLogRank<0.001). Figure 2. The cumulative probability of resective surgery in the total population was 34.2±1.6% after 10 years, 44.9±2.0% after 20 years, and 61.9±4.2% after 30 years. The cumulative probability of first resective surgery between cohorts A/B/C were as follows: 28.7±3.7%/ 26.3±2.1%/ 28.1±2.4% after 5 years; 39.4±4.0%/ 32.6±2.2%/ 33.0±2.7% after 10 years; and 54.5±4.1%/ 41.4±2.6% (cohorts A/B) after 20 years. There were no statistically significant differences in surgery rates between the cohorts overall [pLogRank=0.055], however a notable decrease in long-term (20y) surgery rates was observed comparing cohorts B and C vs. cohort A.Figure 3. A cox-regression multivariate analysis showed that stenosing or penetrating disease (B2/B3) behavior (HR 4.52; 95%CI 3.60-5.68; p<0.001) and ileal (L1) location at diagnosis (HR 1.30; 95%CI 1.05-1.61; p=0.016) were independent predictors of resective surgery.Table 2. Conclusion Disease behavior progression decreased, however no differences in resective surgery risk at 5 and 10 years from diagnosis have been observed in incident CD patients despite the increasing use of immunosuppressives and biologicals in this population based cohort. However, a decrease is shown in long term (20y) surgery risk comparing the earliest cohort to latter ones with higher immunosuppressive and biological use.
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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 | 0.000 | 0.001 |
| 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 | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".