DOP088 Speed of disease progression as hallmark of Crohn’s Disease Severity: The rapid and slow progressors.
Bibliographic record
Abstract
Abstract Background The natural course of Crohn's Disease (CD) can involve the development of intra-abdominal strictures and fistulae (Montreal B2 and B3 phenotypes, respectively). Yet, the speed of disease progression to these phenotypes may differ among patients. This study retrospectively analyses a large cohort of CD patients with luminal phenotype at diagnosis (Montreal B1) and evaluates the speed of disease progression to B2/B3 phenotypes, in a tertiary centre in Belgium. Methods A total of 1,262 IBD patients were screened from the 3000+ inflammatory bowel diseases (IBD) patient’s clinics. Among the 516 CD patients diagnosed after 1999 and meeting the inclusion criteria, 372 presented with a B1 phenotype at diagnosis. Of these, 108 patients progressed to B2/B3 phenotypes during follow-up (FU) and were analysed. Demographics, dynamic disease characteristics and treatment adaptations were collected. Patients were stratified into rapid progressors (within 5 years) and slow progressors (beyond 5 years), based on the median progression time in our cohort of 108 patients (median 5 years [1.8-9.9], Figure 1a). Statistical analyses were performed using Prism. Results Of the 108 patients progressing to B2/B3 phenotypes, 56 (52%) were rapid progressors (median time 1.8 years [0.8–3.5]) and 52 (48%) were slow progressors (median time 10 years [7.0–12.6]; p<0.0001) (Figure 1b). Rapid progressors were older at CD diagnosis (median age 25 years [21–38] vs 19 years [15–24], p<0.0001), as paediatric CD was more prevalent in slow progressors (33% vs 5%, p=0.0003). Although both groups required biologics and surgeries in similar proportions, rapid progressors started biologics earlier (median 1.3 years [0.3–3.1] vs 5.6 years [2.7–8.9], p<0.0001) and underwent surgery for disease progression earlier (median 2 years [1.1–4.3] vs 10 years [6.9–13.4], p<0.0001). All surgeries occurred after B2/B3 progression and slow progressors underwent surgery later after initiating biologics (median 6.7 year [2–9.5] vs 1.2 year [0.3–2.7], p<0.0001 – Figure 1d). Conclusion CD patients with initial B1 phenotype progressing to B2/B3 phenotypes can be classified as rapid and slow progressors based on their speed of progression to these phenotypes. Rapid progressors demonstrate a more aggressive disease course, with earlier biologics initiation and need for surgery. The description of disease progression may uncover a new dynamic disease phenotype of disease severity that is often overlooked or lacking in the current reported cohort and population-based studies. Stratification by the speed of progression may better define patients with severe disease, potentially guiding tailored therapeutic strategies.
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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 | 0.002 |
| 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) | 0.002 | 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".