Development and validation of a blood routine-based extent and severity clinical decision support tool for ulcerative colitis

Abstract

Monitoring extent and severity is vital in the ulcerative colitis (UC) follow-up, however, current assessment is complex and low cost-effectiveness. We aimed to develop a routine blood-based clinical decision support tool, Jin's model, to investigate the extent and severity of UC. The multicentre retrospective cohort study recruited 975 adult UC inpatients and sub-grouped into training, internal validation and external validation set. Model was developed by logistics regression for the extent via Montreal classification and for the severity via Mayo score, Truelove and Witts score (TWS), Mayo endoscopic score (MES) and Degree of Ulcerative colitis Burden of Luminal Inflammation (DUBLIN) score. In Montreal classification, left-sided and extensive versus proctitis model achieved area under the receiver operating characteristic curve (AUROC) of 0.78 and 0.81 retrospectively. For severity, Mayo score model, TWS model, MES model and DUBLIN score model achieved an AUROC of 0.81, 0.70, 0.74 and 0.70 retrospectively. The models also were evaluated with satisfactory calibration and clinical unity. Jin's model was free with open access at http://jinmodel.com:3000/ . Jin's model is a noninvasive, convenient, and efficient approach to assess the extent and severity of UC.

Figure 1

Flow chart of the study population. HMU Harbin medical university, JMSU Jiamusi University, JUCM Heilongjiang University of Chinese Medicine.

Figure 2

The evaluation of models for UC extent (A–F) and severity (G–R). (A–C) present model for distinguishing E2 from E1. (D–F) present model for distinguishing E3 from E1. (G–I) present model for predicting Mayo score. (J–L) present model for predicting TWS. (M–O) present model for predicting MES. (P–R) present model for predicting DUBLIN score. (A,D,G,J,M,P) ROC curves. (B,E,H,K,N,Q) Calibration curves. Smoothed lines fit to the curve and vertical bar illustrates the distribution of predictions. (C,F,I,L,O,R) Decision curves. Red and blue lines represent internal and external validation. Abbreviation: AUROC, area under the receiver operating characteristic.

Figure 3

Online Jin’s model: http://jinmodel.com:3000/. (A) The logo, Website and QR of Jin’ model. (B) The presentation of online Jin’s model. (C) The website outputs model predictions online in English. (D) The website outputs model predictions online in Chinese. QR quick response.

Figure 4

Mechanisms of peripheral blood cells in the pathogenesis of UC. (A) Peripheral blood cells enter from blood into the intestine and mediate the inflammatory response to damage the intestinal barrier. (B) The activated platelets participated in dysfunction of intrinsic and extrinsic blood coagulation. Solid black arrows represented “conversion to”, dashed black arrows represented “release”, red arrows represented “promotion”, green arrows represented “inhibition”, and blue arrows represented “increase and decrease of substances”. APC activated protein C, CD cluster of differentiation, CRP C reactive protein, ENA extractable nuclear antigen, EPCR endothelial protein C receptor, EPCR endothelial protein C receptor, EPO erythropoietin, Fg fibrinogen, GM-CSF granulocyte–macrophage colony-stimulating factor, GP glycoprotein, HETE hydroxy eicosatetraenoic acid, HLA human leukocyte antigen, ICAM intercellular adhesion molecule, IL interleukin, L ligand, MAC membrane attack complex, MCP monocyte chemotactic protein, MPO myeloperoxidase, PAF platelet-activating factor, PC protein C, PDGF platelet-derived growth factor, PF platelet factor, PLAs platelet-leukocyte aggregates, P-LEV platelet-derived large extracellular vesicle, PSGL P-selectin glycoprotein ligand, RANTES regulated upon activation, normal T cell expressed and presumably secreted, ROS reactive oxygen species, TCR T cell receptor, TF tissue factor, TFPI tissue factor pathway inhibitor, Th T helper cell, TL1A tumor necrosis factor-like ligand 1, TLR toll-like receptor, TM thrombomodulin, TNF tumor necrosis factor, TPO thrombopoietin, TXA thromboxane, UC ulcerative colitis, VWF von Willebrand factor.