We assessed Modified Multiplier Simple Endoscopic Score for Crohn’s Disease (MM-SES-CD) and Simple Endoscopic Score for Crohn’s Disease (SES-CD) thresholds that are best associated with low likelihood of long-term disease progression. Data from 61 patients with early Crohn’s disease (CD) who participated in the CALM long-term extension study were used as the derivation cohort and validated using the McMaster inflammatory bowel disease database (n = 99). The primary outcome was disease progression (new internal fistula/abscess, stricture, perianal fistula or abscess, CD-related hospitalization or surgery) since the end of the CALM trial. Optimal MM-SES-CD and SES-CD thresholds were determined using the maximum Youden index. Receiver operating characteristic curve analyses compared threshold scores of remission definitions on disease progression. In the derivation cohort, based on the maximum Youden index, the optimal thresholds associated with a low likelihood of disease progression were MM-SES-CD <22.5 and SES-CD <4. A significantly greater proportion of patients with a MM-SES-CD ≥22.5 had disease progression as compared with patients in the derivation cohort with MM-SES-CD <22.5 (10/17 [58.8%] vs 3/44 [6.8%]; < .001). Similarly, a significantly greater number of patients with SES-CD ≥ 4 had disease progression compared with those with a SES-CD <4 (11/25 [44.0%] vs 2/36 [5.6%]; < .001). Compared with other clinical or endoscopic remission definitions, which demonstrated poor to fair accuracy, MM-SES-CD <22.5 performed the best for predicting disease progression (area under the curve = 0.81; 95% confidence interval, 0.68-0.94; < .001). These thresholds were confirmed in the validation cohort. Achievement of MM-SES-CD <22.5 or SES-CD <4 in patients with ileocolonic or colonic CD is associated with low risk of disease progression and may be suitable targets in clinical trials and practice for endoscopic healing.

中文翻译：

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定义克罗恩病的内镜缓解：MM-SES-CD 和 SES-CD 阈值与疾病进展的低风险相关

我们评估了与长期疾病进展可能性较低相关的克罗恩病改良乘数简单内镜评分 (MM-SES-CD) 和克罗恩病简单内镜评分 (SES-CD) 阈值。参与 CALM 长期扩展研究的 61 名早期克罗恩病 (CD) 患者的数据被用作衍生队列，并使用麦克马斯特炎症性肠病数据库 (n = 99) 进行验证。主要结局是自 CALM 试验结束以来疾病进展（新发内瘘/脓肿、狭窄、肛周瘘或脓肿、CD 相关住院或手术）。最佳 MM-SES-CD 和 SES-CD 阈值是使用最大 Youden 指数确定的。受试者工作特征曲线分析比较了疾病进展缓解定义的阈值分数。在推导队列中，根据最大约登指数，与疾病进展可能性低相关的最佳阈值是 MM-SES-CD <22.5 和 SES-CD <4。与 MM-SES-CD <22.5 的衍生队列中的患者相比，MM-SES-CD ≥ 22.5 的患者出现疾病进展的比例明显更高（10/17 [58.8%] vs 3/44 [6.8%]） ; < .001)。同样，与 SES-CD <4 的患者相比，SES-CD ≥ 4 的患者出现疾病进展的人数显着增多（11/25 [44.0%] vs 2/36 [5.6%]；< .001）。与其他临床或内镜缓解定义相比，MM-SES-CD <22.5 在预测疾病进展方面表现最佳（曲线下面积 = 0.81；95% 置信区间，0.68-0.94；< .001 ）。这些阈值在验证队列中得到了确认。回结肠或结肠 CD 患者达到 MM-SES-CD <22.5 或 SES-CD <4 与疾病进展的低风险相关，可能是临床试验和内镜治疗实践的合适目标。