Prediction Models for Celiac Disease Development in Children From High-Risk Families: Data From the PreventCD Cohort

Caroline R. Meijer*, Renata Auricchio, Hein Putter, Gemma Castillejo, Paula Crespo, Judit Gyimesi, Corina Hartman, Sanja Kolacek, Sibylle Koletzko, Ilma Korponay-Szabo, Eva Martinez Ojinaga, Isabel Polanco, Carmen Ribes-Koninckx, Raanan Shamir, Hania Szajewska, Riccardo Troncone, Vincenzo Villanacci, Katharina Werkstetter, M. Luisa Mearin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: Screening for celiac disease (CD) is recommended in children with affected first-degree relatives (FDR). However, the frequency of screening and at what age remain unknown. The aims of this study were to detect variables influencing the risk of CD development and develop and validate clinical prediction models to provide individualized screening advice. Methods: We analyzed prospective data from the 10 years of follow-up of the PreventCD-birth cohort involving 944 genetically predisposed children with CD-FDR. Variables significantly influencing the CD risk were combined to determine a risk score. Landmark analyses were performed at different ages. Prediction models were created using multivariable Cox proportional hazards regression analyses, backward elimination, and Harrell's c-index for discrimination. Validation was done using data from the independent NeoCel cohort. Results: In March 2019, the median follow-up was 8.3 years (22 days–12.0 years); 135/944 children developed CD (mean age, 4.3 years [range, 1.1–11.4]). CD developed significantly more often in girls (P = .005) and in Human Leukocyte Antigen (HLA)-DQ2 homozygous individuals (8-year cumulative incidence rate of 35.4% vs maximum of the other HLA-risk groups 18.2% [P < .001]). The effect of homozygosity DR3-DQ2/DR7-DQ2 on CD development was only present in girls (interaction P = .04). The prediction models showed good fit in the validation cohort (Cox regression 0.81 [0.54]). To calculate a personalized risk of CD development and provide screening advice, we designed the Prediction application https://hputter.shinyapps.io/preventcd/. Conclusion: Children with CD-FDR develop CD early in life, and their risk depends on gender, age and HLA-DQ, which are all factors that are important for sound screening advice. These children should be screened early in life, including HLA-DQ2/8–typing, and if genetically predisposed to CD, they should get further personalized screening advice using our Prediction application. Trial Registration Number: ISRCTN74582487 (https://www.isrctn.com/search?q=ISRCTN74582487).

Original languageEnglish
Pages (from-to)426-436
Number of pages11
JournalGastroenterology
Volume163
Issue number2
DOIs
StatePublished - Aug 2022
Externally publishedYes

Keywords

  • High-Risk Birth Cohort
  • Individualized Screening Advice
  • Prediction Application
  • Prediction Models
  • Risk Factors

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