BACKGROUND Delays in Crohn's disease (CD) diagnosis are positively associated with ileal location and an increased risk of complications. AIM To develop a simple risk assessment tool to enable primary care physicians to recognise potential ileal CD earlier, shortening the delay to specialist investigation METHODS: Three cohorts were acquired for this study. Cohort 1 included 61 patients retrospectively identified with ileal CD between 2000 and 2010 and 78 matched controls drawn from a cohort referred for investigation of abdominal symptoms. Cohort 2 included 42 individuals diagnosed with ileal CD and 57 controls identified prospectively. Cohort 3 included an additional 84 individuals with ileal CD and 495 without CD referred for colonoscopy. Clinical symptoms and serological biomarkers were acquired and used to develop a risk prediction algorithm. The algorithm was trained independently on each of the three cohorts and tested on the latter two cohorts. RESULTS Altered bowel habit with abdominal pain combined with derangements in white cell count (WCC), albumin and platelet counts were important features in predicting ileal CD (AUC = 0.92, 95% CI = 0.89-0.92). This was validated in cohorts 2 (AUC = 0.96, 95% CI = 0.95-0.98) and 3 (AUC = 0.94, 95% CI = 0.92-0.96). C-reactive protein was independently associated with ileal CD but non-signficant in a multivariate model. CONCLUSION A web-based risk stratification tool for ileal CD has been developed from objective and symptom-based criteria. This tool enables primary care physicians to more confidently request urgent specialist assessment for patients identified as at high risk for ileal CD.

中文翻译：

---

用于检测高风险小肠克罗恩病的经过验证的风险分层工具。

背景技术克罗恩氏病（CD）诊断的延迟与回肠位置和并发症风险增加正相关。目的开发一种简单的风险评估工具，以使基层医疗医生能够及早发现潜在的回肠CD，从而缩短专家调查的时间。方法：本研究获得了三个队列。队列1包括在2000年至2010年期间回顾性鉴定为回肠CD的61例患者，以及从用于腹部症状调查的队列中抽取的78名匹配对照。队列2包括42位被诊断为回肠CD的个体和57位前瞻性对照。队列3包括另外84名具有回肠CD的个体和495名无CD的个体用于结肠镜检查。获得临床症状和血清学生物标志物，并将其用于开发风险预测算法。对该算法分别在三个队列中的每个队列上进行了训练，并在后两个队列中进行了测试。结果肠蠕动习惯改变，腹部疼痛，白细胞计数（WCC），白蛋白和血小板计数紊乱是预测回肠CD的重要特征（AUC = 0.92，95％CI = 0.89-0.92）。这在队列2（AUC = 0.96，95％CI = 0.95-0.98）和3（AUC = 0.94，95％CI = 0.92-0.96）中得到了验证。C反应蛋白与回肠CD独立相关，但在多变量模型中无统计学意义。结论已经从客观和症状为基础的标准开发了基于Web的回肠CD风险分层工具。