Background: Crohn’s disease (CD) is characterized by the development of complications over the course of the disease. It is crucial to identify predictive factors of disabling disease, in order to target patients for early intervention. We evaluated risk factors of disabling CD and developed a prognostic model. Methods: In total, 511 CD patients were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to identify demographic, clinical, and biological risk factors. A predictive nomogram model was developed in a subgroup of patients with noncomplicated CD (inflammatory pattern and no perianal disease). Results: The rate of disabling CD within 5 years after diagnosis was 74.6%. Disabling disease was associated with gender, location of disease, requirement of steroids for the first flare, and perianal lesions. In the subgroup of patients (310) with noncomplicated CD, the rate of disabling CD was 80%. In the multivariate analysis age at onset <40 years (OR = 3.46, 95% confidence interval [CI] = 1.52–7.90), extensive disease (L3/L4) (OR = 2.67, 95% CI = 1.18–6.06), smoking habit (OR = 2.09, 95% CI = 1.03–4.27), requirement of steroids at the first flare (OR = 2.20, 95% CI = 1.09–4.45), and albumin (OR = 0.59, 95% CI = 0.36–0.96) were associated with development of disabling disease. The developed predictive nomogram based on these factors presented good discrimination, with an area under the receiver operating characteristic curve of 0.723 (95% CI: 0.670–0.830). Conclusion: We identified predictive factors of disabling CD and developed an easy-to-use prognostic model that may be used in clinical practice to help identify patients at high risk and address treatment effectively.

1.
Thia
KT
,
Sandborn
WJ
,
Harmsen
WS
,
Zinsmeister
AR
,
Loftus
EV
Jr
.
Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort
.
Gastroenterology
.
2010 Oct
139
4
1147
55
.
2.
Louis
E
,
Collard
A
,
Oger
AF
,
Degroote
E
,
Aboul Nasr El Yafi
FA
,
Belaiche
J
.
Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease
.
Gut
.
2001 Dec
49
6
777
82
.
3.
Dias
CC
,
Pereira Rodrigues
P
,
Fernandes
S
,
Portela
F
,
Ministro
P
,
Martins
D
.
The risk of disabling, surgery and reoperation in Crohn’s disease: a decision tree-based approach to prognosis
.
PLoS One
.
2017 Feb 22
12
2
e0172165
.
4.
Casellas
F
,
López-Vivancos
J
,
Vergara
M
,
Malagelada
J
.
Impact of inflammatory bowel disease on health-related quality of life
.
Dig Dis
.
1999
;
17
(
4
):
208
18
.
5.
Carrière
J
,
Darfeuille-Michaud
A
,
Nguyen
HT
.
Infectious etiopathogenesis of Crohn’s disease
.
World J Gastroenterol
.
2014 Sep 14
20
34
12102
17
.
6.
Loddo
I
,
Romano
C
.
Inflammatory bowel disease: genetics, epigenetics, and pathogenesis
.
Front Immunol
.
2015 Nov 2
6
551
.
7.
Baert
F
,
Caprilli
R
,
Angelucci
E
.
Medical therapy for Crohn’s disease: top-down or step-up
.
Dig Dis
.
2007
;
25
(
3
):
260
6
.
8.
Lin
MV
,
Blonski
W
,
Lichtenstein
GR
.
What is the optimal therapy for Crohn’s disease: step-up or top-down
.
Expert Rev Gastroenterol Hepatol
.
2010 Apr
4
2
167
80
.
9.
Sandborn
WJ
,
Hanauer
S
,
Van Assche
G
,
Panés
J
,
Wilson
S
,
Petersson
J
.
Treating beyond symptoms with a view to improving patient outcomes in inflammatory bowel diseases
.
J Crohns Colitis
.
2014 Sep
8
9
927
35
.
10.
Yang
CH
,
Ding
J
,
Gao
Y
,
Chen
X
,
Yang
ZB
,
Xiao
SD
.
Risk factors that predict the requirement of aggressive therapy among Chinese patients with Crohn’s disease
.
J Dig Dis
.
2011 Apr
12
2
99
104
.
11.
Feldman
PA
,
Wolfson
D
,
Barkin
JS
.
Medical management of Crohn’s disease
.
Clin Colon Rectal Surg
.
2007 Nov
20
4
269
81
.
12.
Gade
AK
,
Douthit
NT
,
Townsley
E
.
Medical management of Crohn’s disease
.
Cureus
.
2020 May 29
12
5
e8351
.
13.
Lima
CCG
,
Queiroz
NSF
,
Sobrado
CW
,
Silva
GLR
,
Nahas
SC
.
Critical analysis of anti-tnf use in the era of new biological agents in inflammatory bowel disease
.
Arq Gastroenterol
.
2020 Jul-Sep
57
3
323
32
.
14.
Tsui
JJ
,
Huynh
HQ
.
Is top-down therapy a more effective alternative to conventional step-up therapy for Crohn’s disease
.
Ann Gastroenterol
.
2018 Jul-Aug
31
4
413
24
.
15.
Peyrin-Biroulet
L
,
Loftus
EV
Jr
,
Colombel
JF
,
Sandborn
WJ
.
The natural history of adult Crohn’s disease in population-based cohorts
.
Am J Gastroenterol
.
2010 Feb
105
2
289
97
.
16.
Beaugerie
L
,
Seksik
P
,
Nion-Larmurier
I
,
Gendre
JP
,
Cosnes
J
.
Predictors of Crohn’s disease
.
Gastroenterology
.
2006 Mar
130
3
650
6
.
17.
Cesarini
M
,
Collins
GS
,
Rönnblom
A
,
Santos
A
,
Wang
LM
,
Sjöberg
D
.
Predicting the individual risk of acute severe colitis at diagnosis
.
J Crohns Colitis
.
2017 Mar 1
11
3
335
41
.
18.
Louis
E
,
Belaiche
J
,
Reenaers
C
.
Tailoring the treatment to the individual in Crohn’s disease
.
Therap Adv Gastroenterol
.
2009 Jul
2
4
239
44
.
19.
Dart
RJ
,
Ellul
P
,
Scharl
M
,
Lamb
CA
.
Results of the seventh scientific workshop of ECCO: precision medicine in IBD: challenges and future directions
.
J Crohns Colitis
.
2021 Sep 25
15
9
1407
9
.
20.
Loly
C
,
Belaiche
J
,
Louis
E
.
Predictors of severe Crohn’s disease
.
Scand J Gastroenterol
.
2008 Aug
43
8
948
54
.
21.
Dias
CC
,
Rodrigues
PP
,
da Costa-Pereira
A
,
Magro
F
.
Clinical prognostic factors for disabling Crohn’s disease: a systematic review and meta-analysis
.
World J Gastroenterol
.
2013 Jun 28
19
24
3866
71
.
22.
Lakatos
PL
,
Czegledi
Z
,
Szamosi
T
,
Banai
J
,
David
G
,
Zsigmond
F
.
Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease
.
World J Gastroenterol
.
2009 Jul 28
15
28
3504
10
.
23.
Unkart
JT
,
Anderson
L
,
Li
E
,
Miller
C
,
Yan
Y
,
Gu
CC
.
Risk factors for surgical recurrence after ileocolic resection of Crohn’s disease
.
Dis Colon Rectum
.
2008 Aug
51
8
1211
6
.
24.
Henckaerts
L
,
Van Steen
K
,
Verstreken
I
,
Cleynen
I
,
Franke
A
,
Schreiber
S
.
Genetic risk profiling and prediction of disease course in Crohn’s disease patients
.
Clin Gastroenterol Hepatol
.
2009 Sep
7
9
972
80.e2
.
25.
Romberg-Camps
MJ
,
Dagnelie
PC
,
Kester
AD
,
Hesselink-van de Kruijs
MA
,
Cilissen
M
,
Engels
LG
.
Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease
.
Am J Gastroenterol
.
2009 Feb
104
2
371
83
.
26.
Louis
E
,
Michel
V
,
Hugot
JP
,
Reenaers
C
,
Fontaine
F
,
Delforge
M
.
Early development of stricturing or penetrating pattern in Crohn’s disease is influenced by disease location, number of flares, and smoking but not by NOD2/CARD15 genotype
.
Gut
.
2003 Apr
52
4
552
7
.
27.
To
N
,
Ford
AC
,
Gracie
DJ
.
Systematic review with meta-analysis: the effect of tobacco smoking on the natural history of ulcerative colitis
.
Aliment Pharmacol Ther
.
2016 Jul
44
2
117
26
.
28.
Zabana
Y
,
Panés
J
,
Nos
P
,
Gomollón
F
,
Esteve
M
,
García-Sánchez
V
.
The ENEIDA registry (Nationwide study on genetic and environmental determinants of inflammatory bowel disease) by GETECCU: design, monitoring and functions
.
Gastroenterol Hepatol
.
2020 Nov
43
9
551
8
. English, Spanish.
29.
Lennard-Jones
JE
.
Classification of inflammatory bowel disease
.
Scand J Gastroenterol Suppl
.
1989
;
170
:
2
6
; discussion 16-9.
30.
Silverberg
MS
,
Satsangi
J
,
Ahmad
T
,
Arnott
ID
,
Bernstein
CN
,
Brant
SR
.
Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology
.
Can J Gastroenterol
.
2005 Sep
19
Suppl A
5A
36A
.
31.
Zhang
Z
,
Kattan
MW
.
Drawing Nomograms with R: applications to categorical outcome and survival data
.
Ann Transl Med
.
2017 May
5
10
211
.
32.
Louis
E
,
Mary
JY
,
Vernier-Massouille
G
,
Grimaud
JC
,
Bouhnik
Y
,
Laharie
D
.
Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped
.
Gastroenterology
.
2012 Jan
142
1
63
70.e5
; quiz e31.
33.
Williams
JL
,
Shaffer
VO
.
Modern management of perianal Crohn's disease: a review
.
Am Surg
.
2021 Sep
87
9
1361
7
.
34.
Dotan
I
.
Disease behavior in adult patients: are there predictors for stricture or fistula formation
.
Dig Dis
.
2009
;
27
(
3
):
206
11
.
35.
Adegbola
SO
,
Sahnan
K
,
Twum-Barima
C
,
Iqbal
N
,
Reza
L
,
Lung
P
.
Current review of the management of fistulising perianal Crohn’s disease
.
Frontline Gastroenterol
.
2021
;
12
(
6
):
515
23
.
36.
Colombel
JF
,
Sandborn
WJ
,
Reinisch
W
,
Mantzaris
GJ
,
Kornbluth
A
,
Rachmilewitz
D
.
Infliximab, azathioprine, or combination therapy for Crohn’s disease
.
N Engl J Med
.
2010 Apr 15
362
15
1383
95
.
37.
D'Haens
G
,
Baert
F
,
van Assche
G
,
Caenepeel
P
,
Vergauwe
P
,
Tuynman
H
.
Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial
.
Lancet
.
2008 Feb 23
371
9613
660
7
.
38.
Baert
F
,
Moortgat
L
,
Van Assche
G
,
Caenepeel
P
,
Vergauwe
P
,
De Vos
M
.
Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn’s disease
.
Gastroenterology
.
2010 Feb
138
2
463
8
; quiz e10-1.
39.
Salahudeen
MS
.
A review of current evidence allied to step-up and top-down medication therapy in inflammatory bowel disease
.
Drugs Today
.
2019 Jun
55
6
385
405
.
40.
Chen
QQ
,
Yan
L
,
Wan
J
.
Select a suitable treatment strategy for Crohn's disease: step-up or top-down
.
EXCLI J
.
2014 Feb 13
13
111
22
.
41.
Su
Q
,
Li
X
,
Mo
W
,
Yang
Z
.
Low serum bilirubin, albumin, and uric acid levels in patients with Crohn’s disease
.
Medicine
.
2019 May
98
19
e15664
.
42.
Yao
J
,
Jiang
Y
,
Ke
J
,
Lu
Y
,
Hu
J
,
Zhi
M
.
A validated prognostic model and nomogram to predict early-onset complications leading to surgery in patients with Crohn’s disease
.
Dis Colon Rectum
.
2021 Jun 1
64
6
697
705
.
43.
Zhu
F
,
Li
Y
,
Guo
Z
,
Cao
L
,
Feng
D
,
Zhang
T
.
Nomogram to predict postoperative intra-abdominal septic complications after bowel resection and primary anastomosis for Crohn’s disease
.
Dis Colon Rectum
.
2020 May
63
5
629
38
.
44.
He
Y
,
Zhu
Z
,
Chen
Y
,
Chen
F
,
Wang
Y
,
Ouyang
C
.
Development and validation of a novel diagnostic nomogram to differentiate between intestinal tuberculosis and Crohn’s disease: a 6-year prospective multicenter study
.
Am J Gastroenterol
.
2019 Mar
114
3
490
9
.
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