D2 | Abstract 15

Annual NUTRIM Symposium 18 November 2020


Histological features of chronicity in diagnostic biopsies can predict a severe disease course in Crohn’s disease patients

A. Rezazadeh Ardabili1,2, D. Goudkade3, H.I. Grabsch4, M.J. Pierik1,2, D.M. Jonkers1,2

1 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, The Netherlands
2 School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center+, Maastricht, The Netherlands
3 Department of Pathology, Zuyderland Medical Center, Geleen, The Netherlands
4 Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
Predicting the course of Crohn’s disease (CD) is relevant for treatment selection. Currently, adequate predictors are lacking. This study aimed to investigate the additive predictive value of histopathological features to discriminate between a long-term mild and severe disease course.

Diagnostic biopsies from patients with a mild or severe disease course during the first 10 years after diagnosis were examined retrospectively by two GI pathologists using a standardized form to score 15 histopathological features related to acute and chronic inflammation. Two multivariable logistic regression models were built to assess the predictive value of clinically relevant baseline characteristics alone (Model 1: Montreal classification; Model 2: first model expanded with smoking status and gender). Subsequently, histopathological features were added to Model 2 to identify relevant features and to adjust for baseline characteristics. Predicted probabilities of regression models were calculated and used to compute receiver operating characteristics (ROC) curves.

In total, 506 biopsies from 82 treatment-naïve patients (40 mild, 42 severe) were studied. Based on clinical baseline characteristics alone, disease course could only be moderately predicted (Model 1 AUROC:0.758, 95%CI 0.66-0.86, sensitivity 78.6%, specificity 72.5%; Model 2 AUROC:0.784 (0.68-0.88), sensitivity 90.5%, specificity 57.5%). When adding histopathological features, basal plasmacytosis was identified as a significant predictor of severe disease course in colonic biopsies (AUROC:0.827 (0.74-0.92), sensitivity 94.4%, specificity 59.5%). Finally, a combination of (1) basal plasmacytosis, (2) severe lymphocyte and plasma cell infiltration in lamina propria, (3) Paneth cell metaplasia and (4) absence of ulcers was superior for prediction (AUROC:0.896 (0.82-0.97), sensitivity 91,7%, specificity 78,4%).

In this first study investigating the predictive value of histopathological features in diagnostic CD biopsies, we found that certain features of chronic inflammation in colonic biopsies contribute to prediction of a long-term severe disease course, thereby presenting a novel approach to improve patient stratification and facilitate clinical decision making.

NUTRIM | School of Nutrition and Translational Research in Metabolism
NUTRIM aims to contribute to health maintenance and personalised medicine by unraveling lifestyle and disease-induced derangements in metabolism and by developing targeted nutritional, exercise and drug interventions. This is facilitated by a state of the art research infrastructure and close interaction between scientists, clinicians, master and PhD students.