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Objectives <p>Magnetic resonance enterography (MRE) is a first-line investigation to diagnose Crohn’s disease (CD), but its role for prognostication is unknown. Accordingly, we assessed the predictive ability of prognostic models including MRE scores (MRE Global Score (MEGS), simplified MR Index of Activity (sMARIA), and Lémann index (LI)) against models using clinical predictors alone for the development of modified Beaugerie disabling CD (MBDD) within 5 years of diagnosis.</p> Methods <p>This was a multicentre, diagnostic inception cohort of patients with newly diagnosed CD across 9 UK hospitals, followed for 4 years or more. We censored development of MBDD ≤ 90 days from diagnosis, and used time-to-event models using Royston-Parmer flexible parametric models.</p> Results <p>We included 194 patients, median age 29, IQR 22–44 years, 52% female. Within 5 years of diagnosis, 42% (81/194) developed MBDD. In univariable analysis, initial steroid requirement was associated with increased risk of developing MBDD (HR 2.11 (95% CI 1.36, 3.26). The baseline clinical model had 49% (39, 60) sensitivity and 66% (57, 74) specificity for predicting the top 40% of patients with the greatest risk of developing MBDD, and 86% (77, 92) sensitivity and 35% (27, 45) specificity for predicting the development of MBDD in patients with an absolute risk of ≥ 10%. There was no significant difference in sensitivity when the MEGS, sMARIA, or LI were added to the baseline clinical model.</p> Conclusions <p>Addition of MRE scores at diagnosis to a multivariable model comprising clinical predictors did not improve prediction of MBDD within 5 years of diagnosis.</p> <b>Key Points</b> <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Magnetic resonance enterography (MRE) is important for diagnosing and monitoring Crohn’s disease (CD), but primary research evaluating its prognostic role is lacking</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Adding MRE findings at diagnosis to a multivariable model comprising clinical predictors did not improve the prediction of disabling CD within 5 years of diagnosis</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>When tested in a prospective, multicentre trial, current MRE activity and damage scores at diagnosis did not reliably predict whether patients would subsequently develop disabling CD. Notwithstanding this finding, MRE remains an essential tool for diagnosis and monitoring</i>.</p> Graphical Abstract <p></p>

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Magnetic resonance enterography to predict subsequent disabling Crohn’s disease in newly diagnosed patients (METRIC-EF)—multivariable prediction model, multicentre diagnostic inception cohort

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月14日

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  • Stuart A. Taylor,
  • Shankar Kumar,
  • Thomas Parry,
  • Sue Mallett,
  • Simon Travis,
  • Tim Raine,
  • Caroline Clarke,
  • Jing Yi Weng,
  • Gauraang Bhatnagar,
  • Stuart Bloom,
  • Peter John Hamlin,
  • Ailsa Hart,
  • Roser Vega,
  • Maira Hameed,
  • Anisha Bhagwanani,
  • Rebecca Greenhalgh,
  • Emma Helbren,
  • James Stephenson,
  • Ian Zealley,
  • Vivienne Eze,
  • Jamie Franklin,
  • Alison Corr,
  • Arun Gupta,
  • Damian Tolan,
  • William Hogg,
  • Antony Higginson,
  • Mohamed Ahmed,
  • Louise Lee,
  • Richard Pollok,
  • Jaymin Patel,
  • Samantha Baillie,
  • Steve Halligan,
  • Andrew Plumb

摘要

Objectives

Magnetic resonance enterography (MRE) is a first-line investigation to diagnose Crohn’s disease (CD), but its role for prognostication is unknown. Accordingly, we assessed the predictive ability of prognostic models including MRE scores (MRE Global Score (MEGS), simplified MR Index of Activity (sMARIA), and Lémann index (LI)) against models using clinical predictors alone for the development of modified Beaugerie disabling CD (MBDD) within 5 years of diagnosis.

Methods

This was a multicentre, diagnostic inception cohort of patients with newly diagnosed CD across 9 UK hospitals, followed for 4 years or more. We censored development of MBDD ≤ 90 days from diagnosis, and used time-to-event models using Royston-Parmer flexible parametric models.

Results

We included 194 patients, median age 29, IQR 22–44 years, 52% female. Within 5 years of diagnosis, 42% (81/194) developed MBDD. In univariable analysis, initial steroid requirement was associated with increased risk of developing MBDD (HR 2.11 (95% CI 1.36, 3.26). The baseline clinical model had 49% (39, 60) sensitivity and 66% (57, 74) specificity for predicting the top 40% of patients with the greatest risk of developing MBDD, and 86% (77, 92) sensitivity and 35% (27, 45) specificity for predicting the development of MBDD in patients with an absolute risk of ≥ 10%. There was no significant difference in sensitivity when the MEGS, sMARIA, or LI were added to the baseline clinical model.

Conclusions

Addition of MRE scores at diagnosis to a multivariable model comprising clinical predictors did not improve prediction of MBDD within 5 years of diagnosis.

Key Points

Question Magnetic resonance enterography (MRE) is important for diagnosing and monitoring Crohn’s disease (CD), but primary research evaluating its prognostic role is lacking.

Findings Adding MRE findings at diagnosis to a multivariable model comprising clinical predictors did not improve the prediction of disabling CD within 5 years of diagnosis.

Clinical relevance When tested in a prospective, multicentre trial, current MRE activity and damage scores at diagnosis did not reliably predict whether patients would subsequently develop disabling CD. Notwithstanding this finding, MRE remains an essential tool for diagnosis and monitoring.

Graphical Abstract