P201 Assessment of factors associated with cumulative bowel damage in surgically naïve patients using Lemann index and global MaRIA index in Crohn’s disease
Bibliographic record
Abstract
Abstract Background The Lémann index (LI) is a unique tool that measures cumulative bowel damage in Crohn’s disease (CD) and is composed of surgical procedures and severity and extent of bowel lesions according to endoscopy and MR enterography (MRE). Since there is a significant contribution of previous surgery in LI calculation, our aim of this study is to investigate factors associated with cumulative bowel damage using LI in both total population and surgically naïve patients. Methods In this cross-sectional study, LI was calculated evaluating 20 small bowel, 7 large bowel and 3 upper GI segments. For each segment bowel resections, inflammatory, stricturing or penetrating lesions were considered using MRE and upper and lower endoscopy. Global MaRIA (gMaRIA) index was calculated using following parameters on 6 bowel segments on MRE: bowel wall thickness, ulcers, edema, and relative contrast enhancement. Longstanding disease was ≥10-year duration. Disease activity was defined as CRP>5 or HBI≥5. Extent and disease behavior were assessed using Montreal classification. Multivariate logistic regression adjusted for confounders was performed (age, gender, BMI, smoking status, CRP, disease behavior and extension, biological therapy, gMaRIA score, and HBI). Results This study included 320 CD patients [age 36 (24-46), 54.6% males, disease duration 7.2 (1-14) years, BMI 21.3 (17.4-24.8) kg/m2]. There were 142 (44.4%) surgically naïve and 128 (40%) patients with longstanding disease. In total population, higher LI values were observed among those with longstanding disease (10.31 vs 5.35 years, p<0.001), patients treated with biological therapy (9.7 vs. 6.4, p=0.005) and prior surgery (11.81 vs. 1.62, p<0.005). There was no difference in LI according to activity (p=0.921) and smoking status (p=0.336). Multivariate analysis on total population revealed independent predictors of elevated LI which were BMI (β=-0.268, p<0.02), disease duration (β=0.120, p=0.041) and prior surgery (β=5.42, p<0.001). Hence, separate multivariate analysis was performed on surgically naïve which revealed following predictors of LI (other than surgery): current smoking (β=1.14, p=0.010), perianal disease (β=1.39, p=0.02) and gMaRIA score (β=0.093, p<0.001). Conclusion Positive predictors of cumulative bowel damage in surgically naïve patients were smoking, perianal disease, and radiological activity (gMaRIA), while in total population longer disease duration, BMI and prior surgery. There are several important contributing variables on cumulative bowel damage which were revealed after removing previously operated patients, which would otherwise remain unrecognized. This risk factors in CD could stratify patients at high risk for complicated course of disease.
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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 | 0.001 |
| 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) | 0.003 | 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".