4. Discussion
inflammatory bowel disease, disease behavior, inflammation, postoperative intestinal fistula, fistula, cancers of the gastrointestinal tract, stricturing CD, hepatitis, postoperative infectious complications
DISEASE PROGRESSION, RECURRENCE, CARDIOVASCULAR DISEASE, INFLAMMATORY BOWEL DISEASE, POSTOPERATIVE COMPLICATIONS, INFLAMMATION, DISEASE, REMISSION, PANCREATITIS, REGRESSION, HEPATITIS, INFLAMMATORY DISEASE, COMPLICATIONS
Among patients with CD, 90% undergo surgery during disease progression, and 50% require a second operation. Thus, surgery remains a major treatment modality for CD.Various single serological indicators have low specificity and large errors in evaluating postoperative complications in patients with CD. In light of this, the aim of the present study was to evaluate disease activity and the development of postoperative complications in CD by establishing composite serologic indexes. By collecting clinical data and serological indicators of patients with CD from 3 large tertiary hospitals, it was found that NLR, PLR, CAR, SII, and PNI were all factors influencing the development of postoperative intestinal fistula. High NLR and low PNI were risk factors for postoperative intestinal fistula; the higher the NLR, the greater the risk of postoperative intestinal fistula, and the higher the PNI, the lower the risk of postoperative intestinal fistula. NLR and PLR can be determined easily from complete blood count and have been confirmed as biomarkers of inflammation and to be important in disease prognosis. Several studies have reported their correlation with the prognosis of inflammatory diseases such as acute/chronic pancreatitis; hepatitis; cancers of the gastrointestinal tract, liver, and pancreas; as well as cardiovascular disease, and it has also been used to assess CD activity.The results of the present study showed that the CDAI score is a factor influencing the development of postoperative enterocutaneous fistula in patients with CD. Multivariate logistic regression analysis suggested that higher disease activity resulted in a higher risk of postoperative intestinal fistula. The CDAI score can be used for assessing current disease activity in patients with CD, as well as for dynamic monitoring of changes in disease activity after CD treatment. It can also indicate the recurrence of symptoms after surgery, making it a benchmark for measuring disease severity, clinical response, and remission rates. A study showed a higher incidence of postoperative infectious complications in patients with active CD than in patients in remission.The present study suggested that disease behavior influences the development of postoperative intestinal fistula in patients with CD. Multivariate logistic regression analysis suggested that the risk was significantly higher in patients with stricturing CD than in patients with non-stricturing and non-perforating CD. Perforating CD was not an independent risk factor for the development of postoperative intestinal fistula. Wang et alThere is a lack of domestic and international predictive models related to the development of postoperative intestinal fistula in patients with CD. Therefore, it is important to construct practical risk models with high predictive value to help stratify at-risk patients. Based on this predictive model, clinicians can identify patients at higher risk of developing enterocutaneous fistula after surgery at an early stage, which is also significant for earlier recovery after surgery. Studies have shown that nomograms have high accuracy and ease of application in predicting disease occurrence.As a retrospective analysis, this study had some limitations. First, the study results may have been influenced by factors such as recall bias and follow-up timeframe. Second, the present study only observed the development of postoperative intestinal fistula, whereas the reoperation rate, hospitalization rate, and the development of other complications were not analyzed. Therefore, we expect that more data from patients with CD in inflammatory bowel disease centers and more comprehensive clinical data from patients will be collected in future prospective cohort studies to confirm the accuracy and utility of this prediction model.In conclusion, there is a lack of domestic and international multicenter studies and nomogram models of risk factors for the development of postoperative intestinal fistula after CD. Studying the pattern of CD progression, identifying independent influencing factors for postoperative intestinal fistula in CD, and facilitating aggressive intervention against high-risk factors, thus reducing the incidence of postoperative intestinal fistula in patients with CD, enables patients to reap greater benefits from treatment. The predictive model was validated externally using the validation set to effectively predict the risk of postoperative enterocutaneous fistula, which partially informs the development and adjustment of perioperative treatment plans and management strategies for patients with CD. Individuals at higher risk of developing enterocutaneous fistula should be provided early symptomatic interventions to reduce the risk of postoperative enterocutaneous fistula, thus allowing them to derive greater benefit from treatment and reduce suffering.