Early predictors of induction of remission with exclusive enteral nutrition in children with Crohn's disease.

Abstract

Background: Exclusive enteral nutrition (EEN) is recommended as first-line therapy for children with mild to moderate Crohn's disease (CD), given its effectiveness in inducing clinical remission (CR) and promoting mucosal healing (MH). However, the identification of reliable early predictors of EEN response remains an area requiring further investigation.

Methods: Patients with CD diagnosed between 2015 and 2024 were divided into training and validation cohorts. Baseline clinical and laboratory covariates were analyzed separately to evaluate their associations with CR and MH after 8 weeks of EEN therapy. Significant covariates were identified through univariate analysis and correlation tests, followed by their inclusion in stepwise logistic regression to develop separate predictive models for CR and MH. Model performance was evaluated using receiver operating characteristic (ROC) curves.

Results: A total of 56 patients were included in the derivation cohort, and 28 were included in the validation cohort. The CR diagnostic model achieved an Area Under Curve (AUC) of 0.93 in the derivation cohort (95% confidence interval (CI) 0.87-1.00; p < 0.05) and 0.82 in the validation cohort (95% CI 0.62-1.02; p < 0.05). Higher baseline levels of IBIL (> 4.95 µmol/L), T-cell cluster of differentiation 3 (CD3) (> 76.78%), and iron (> 9.025 mmol/L) were associated with reduced CR rates. The MH diagnostic model yielded an AUC of 0.87 in the derivation cohort (95% CI 0.73-1.00; p < 0.05) and 0.66 in the validation cohort (95% CI 0.43-0.89; p = 0.231). Factors associated with lower MH rates included an Interleukin 10 (IL-10) level > 4.35 µmol/L and a red cell distribution width (RDW) > 14.55%.

Conclusion: IBIL, CD3 and iron levels are reliable predictors of the induction of CR with EEN, whereas the IL-10 level and RDW serve as early predictors of MH.