44 Factors associated with Fistulizing Crohn’s disease in children at diagnosis: A cross-sectional cohort study
Bibliographic record
Abstract
Abstract Background Perianal manifestations are common at diagnosis of Crohn’s Disease (CD) in paediatric patients, occurring in approximately 25% of children with CD. Perineal Crohn’s disease (PCD) includes perianal fistulas, abscesses, fissures, and inflammatory anal skin tags. Perianal fistulizing Crohn’s disease (PFCD) is a form of PCD in which patients present with perianal fistulas and/or abscesses and it often dictates a poor prognosis in children. Studies demonstrate that PFCD is associated with more complications and increased severity over the course of the disease. Thus, early identification of PFCD is crucial in children with CD to adjust treatment plans and intervene before symptoms worsen. However, predictive factors of PFCD in children remain poorly understood, and no preventative measures have been established. Objectives This study’s primary aim was to investigate the factors associated with PFCD at paediatric CD diagnosis. Its secondary aims were to assess factors associated with PFCD’s severity with the Van Assche score (VAS), characterize the prevalence of PCD/PFCD in a Canadian cohort, and evaluate PCD management at diagnosis. Design/Methods In this cross-sectional single-center study, data was collected from paediatric patients (4-18 years old) diagnosed with CD between 2009 and 2021 at a single IBD center, with all patients undergoing a perineal magnetic resonance imaging (MRI) within 3 months of CD diagnosis. PCD was assessed clinically, endoscopically and through MRI results that rated perianal disease severity using the Van Assche Score (VAS) ranging from 0 to 22. With the data obtained from clinical charts, multivariate analyses were conducted to evaluate the association between clinical, laboratory, endoscopic and histological factors and PFCD and its severity. Results A total of 489 patients were included in the study (57.9% males; median age 13.8 years [(interquartile range (IQR)=11.4-15.5)], of which 229 (46.8%) had PCD. PFCD was identified with MRI in 115 patients (23.5%), with 13.9% (16/115) showing no clinical perineal manifestations at diagnosis of CD. The median VAS for patients with PFCD was 13.0 [(IQR)=(9.0-15.0)] as compared to 2.0 [(IQR)=(0.0-2.0)] in patients without PFCD (p<0.0001). Male sex (OR=3.04 [1.37-6.74]), the presence of granulomas on intestinal biopsies (OR=3.30 [1.54-7.08]) and anal fissures (OR=5.69 [2.13-15.18]) at diagnosis were factors associated with PFCD and a higher VAS. Conclusion This study highlights the importance of early perianal MRI at CD diagnosis as occult PFCD may be discovered. Male sex, the presence of granulomas on intestinal biopsies and anal fissures at diagnosis were associated with PFCD and more severe PCD in paediatric patients.
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| 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".