Abstract
Despite advances in therapeutic strategies, including biologic and small-molecule agents, many Crohns disease (CD) patients in remission or with mild activity based on Crohns Disease Activity Index still require abdominal surgery, yet current predictive tools remain insufficient. This study developed and validated a practical prediction model using routine clinical data to assess long-term surgical risk in this population. This retrospective cohort study analyzed 615 incident CD patients diagnosed between 2016 and 2022. Using backward stepwise Cox regression, we developed a prediction model incorporating only readily available clinical parameters. Model performance was evaluated through Harrells C-index, time-dependent ROC analysis, and calibration curves, with bootstrap validation for internal verification. Five surgical predictors emerged: C-reactive protein (HR = 1.06, 95% CI: 1.03–1.10), fibrinogen (HR = 0.71, 95% CI: 0.59–0.85), albumin (HR: 0.67, 95% CI: 0.50–0.90), Montreal B classification (HR of B2 = 2.28, 95% CI: 1.30–4.00, HR of B3 = 4.13, 95% CI: 2.56–6.65), the use of advanced therapy (HR 0.63, 95% CI 0.42–0.92). The model demonstrated excellent predictive performance, with a Harrells C-index of 0.728 (95% CI: 0.677–0.779), and maintained time-dependent AUC values of 0.729–0.766 across 0.5–5 years. Bootstrap validation showed consistent performance (mean C-index: 0.733; time-dependent AUC: 0.731–0.773) with excellent calibration, confirming the models stability and clinical utility for long-term prediction. Risk stratification based on the cox model effectively categorized patients into low-, intermediate-, and high-risk groups (P < 0.001). Additionally, an online platform to enable clinical guidance: https://crohndisease.shinyapps.io/CDAI0-1/.The prediction model incorporating routinely available clinical variables to accurately predict abdominal surgery risk in CD patients in remission or with mild activity, supporting clinical decision-making.
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Data availability
The datasets utilized in the present study can be obtained from the corresponding author upon reasonable request.
Abbreviations
- ALB:
-
Albumin
- APTT:
-
Activated partial thromboplastin time
- BMI:
-
Body mass index
- CD:
-
Crohns disease
- CRP:
-
C-Reactive protein
- DD:
-
D-dimer
- ESR:
-
Erythrocyte sedimentation rate
- Fg:
-
Fibrinogen
- Hb:
-
Hemoglobin
- PT:
-
Prothrombin time
- TT:
-
Thrombin time
- WBC:
-
White blood cell count
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Acknowledgements
We highly appreciate all the patients who were involved in the study and the guidance and dedication of the Pro. Yuan.
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Conceptualization: K.X., H.Y., L.Y., L.Y. Data curation: Z.J., H.L., Q.S. Formal analysis: K.X., H.Y., L.Y. Visualization: K.X., H.Y., L.Y. Writing – original draft: K.X., H.Y., Z.J., H.L., Q.S., L.Y., L.Y. Writing – review & editing: K.X., H.Y., Z.J., H.L., Q.S., L.Y., L.Y. Funding acquisition: L.Y. All authors reviewed the manuscript
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This study was approved by the Ethics Committee of Xiangya Second Hospital (Ethics ID: LYEC2025-0156), and followed the Declaration of Helsinki. Patient data were anonymized throughout the study. As this was a retrospective study, informed consent was waived.
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Xie, K., Yao, H., Jiang, Z. et al. A web-based prediction model using routinely available clinical variables to estimate surgical risk in Crohn’s disease during remission or mild activity. Sci Rep (2026). https://doi.org/10.1038/s41598-026-48056-7
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DOI: https://doi.org/10.1038/s41598-026-48056-7
