Association of prealbumin with risk of abdominal surgery and endoscopic recurrence in Crohn’s disease: A machine learning study

doi:10.3748/wjg.119629

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Sep 28, 2026; 32(36): 119629
Published online Sep 28, 2026. doi: 10.3748/wjg.119629

Table 1 Baseline characteristics of the cohort of newly diagnosed Crohn’s disease patients, n (%)/median (interquartile range)

Characteristics	Total cohort	Q1	Q2	Q3	Q4	P value
	1060	265	265	265	265
Demographics						< 0.001
Gender						0.007
Female	274 (25.8)	86 (32.5)	74 (27.9)	59 (22.3)	55 (20.8)
Male	786 (74.2)	179 (67.5)	191 (72.1)	206 (77.7)	210 (79.2)
Smoking						0.674
Yes	216 (20.4)	56 (21.1)	47 (17.7)	56 (21.1)	57 (21.5)
No	844 (79.6)	209 (78.9)	218 (82.3)	209 (78.9)	208 (78.5)
BMI (kg/m²)	18.5 (16.7, 20.9)	18.4 (16.6, 20.8)	18.4 (16.8, 20.9)	18.4 (17.0, 20.8)	18.7 (16.7, 21.1)	0.982
Laboratory tests
WBC (10⁹)	6.44 (5.04, 8.21)	7.07 (5.39, 9.43)	7.35 (5.57, 9.3)	5.91 (4.7, 7.23)	5.92 (4.82, 7.41)	< 0.001
NLR	1.51 (0.8, 3.02)	2.53 (1.32, 5.59)	1.56 (0.80, 3.24)	1.18 (0.64, 2.33)	1.10 (0.68, 2.35)	< 0.001
LMR	4.16 (2.77, 6.55)	4.13 (2.84, 6.59)	4.27 (2.91, 6.35)	4.16 (2.99, 6.18)	4.12 (2.50, 6.66)	0.96
CRP (mg/dL)	1.44 (0.46, 3.94)	5.90 (2.15, 8.91)	2.11 (0.83, 4.32)	0.82 (0.30, 1.68)	0.59 (0.24, 1.32)	< 0.001
Hb (g/dL)	12.1 (10.3, 13.6)	10.3 (8.6, 12.1)	11.8 (10.4, 13.2)	12.4 (10.8, 13.9)	13.5 (11.8, 14.7)	< 0.001
ESR (mm/hour)	21 (9, 43)	44 (26, 59)	25 (13, 44)	14 (7, 30)	11 (6, 21)	< 0.001
PA (mg/L)	194.4 (139.6, 243.2)	101.4 (77.5, 126.2)	168.9 (152.8, 180.5)	215.5 (209.1, 227.1)	264.6 (252.4, 279.9)	< 0.001
ALB (g/dL)	3.7 (3.22, 4.13)	2.53 (1.32, 5.59)	1.56 (0.80, 3.24)	1.18 (0.64, 2.33)	1.10 (0.68, 2.35)	< 0.001
PT (seconds)	12 (11.1, 13)	12.7 (11.7, 13.7)	12.1 (11.4, 13)	11.6 (10.9, 12.3)	11.6 (11, 12.3)	< 0.001
Fg (g/L)	3.7 (2.9, 4.6)	4.31 (3.4, 5.03)	3.8 (3.2, 4.8)	3.31 (2.6, 4.05)	3.2 (2.4, 3.9)	< 0.001
D-dimer (mg/L)	0.33 (0.19, 0.64)	0.57 (0.34, 1.00)	0.34 (0.20, 0.64)	0.28 (0.17, 0.54)	0.26 (0.15, 0.45)	< 0.001
Crohn’s disease related
Montreal classification A						0.86
A1	133 (12.5)	35 (13.2)	34 (12.8)	34 (12.8)	30 (11.3)
A2	788 (74.3)	189 (71.3)	200 (75.5)	197 (74.3)	202 (76.2)
A3	139 (13.1)	41 (15.5)	31 (11.7)	34 (12.8)	33 (12.5)
Montreal classification B						0.074
B1	473 (44.6)	124 (46.8)	123 (46.4)	129 (48.7)	97 (36.6)
B2	346 (32.6)	84 (31.7)	90 (34.0)	78 (29.4)	94 (35.5)
B3	241 (22.7)	57 (21.5)	52 (19.6)	58 (21.9)	74 (27.9)
Montreal classification L						< 0.001
L1	268 (25.3)	55 (20.8)	57 (21.5)	78 (29.4)	78 (29.4)
L2	67 (6.3)	23 (8.7)	28 (10.6)	2 (0.8)	14 (5.3)
L3	711 (67.1)	183 (69.1)	176 (66.4)	182 (68.7)	170 (64.2)
L4	14 (1.3)	4 (1.5)	4 (1.5)	3 (1.1)	3 (1.1)
CDAI						0.205
Remission	133 (12.5)	32 (12.1)	34 (12.8)	39 (14.7)	28 (10.6)
Mild activity	482 (45.5)	113 (42.6)	120 (45.3)	122 (46.0)	127 (47.9)
Moderate activity	392 (37.0)	101 (38.1)	104 (39.2)	95 (35.8)	92 (34.7)
Severe activity	53 (5.0)	19 (7.2)	7 (2.6)	9 (3.4)	18 (6.8)
Perianal abscess						0.336
No	687 (64.8)	184 (69.4)	168 (63.4)	169 (63.8)	166 (62.6)
Yes	373 (35.2)	81 (30.6)	97 (36.6)	96 (36.2)	99 (37.4)
Use of drugs
5-aminosalicylic acid	90 (9.0)	23 (8.7)	18 (6.8)	28 (10.6)	21 (7.9)	0.241
Steroid	152 (14.3)	34 (12.8)	44 (16.6)	34 (12.8)	40 (15.1)	0.365
Immunosuppressant	261 (24.6)	55 (20.8)	70 (26.4)	64 (24.2)	72 (27.2)	0.115
Biological agent	667 (62.9)	153 (57.7)	159 (60.0)	179 (67.5)	176 (66.4)	0.049

BMI: Body mass index; WBC: White blood cells; NLR: Neutrophil-to-lymphocyte ratio; LMR: Lymphocyte-to-monocyte ratio; CRP: C-reactive protein; Hb: Haemoglobin; ESR: Erythrocyte sedimentation rate; PA: Prealbumin; ALB: Albumin; PT: Prothrombin time; Fg: Fibrinogen; CDAI: Crohn’s Disease Activity Index.

Full Size Table

Table 2 Baseline characteristics of the primary Crohn’s disease surgical cohort, n (%)/median (interquartile range)

Characteristics	Total cohort	Q1	Q2	Q3	Q4	P value
	282	71	71	70	70
Demographics
Gender						0.069
Female	62 (22.0)	19 (26.8)	20 (28.2)	15 (21.4)	8 (11.4)
Male	220 (78.0)	52 (73.2)	51 (71.8)	55 (78.6)	62 (88.6)
Smoking						0.977
Yes	93 (33.0)	24 (33.8)	22 (31.0)	24 (34.3)	23 (32.9)
No	189 (67.0)	47 (66.2)	49 (69.0)	46 (65.7)	47 (67.1)
BMI (kg/m²)	17.9 (15.9, 20.1)	17.0 (15.1, 19.1)	17.8 (15.9, 20.4)	18.0 (16.9, 20.4)	17.8 (16.0, 20.1)	0.155
Laboratory tests
WBC (10⁹)	5.86 (4.27, 7.78)	6.40 (4.46, 9.02)	5.29 (4.14, 8.38)	6.19 (4.77, 7.50)	5.40 (4.21, 7.06)	0.173
NLR	3.73 (2.41, 6.10)	5.26 (3.54, 10.2)	3.88 (2.17, 6.60)	3.18 (2.45, 4.68)	3.34 (2.20, 5.07)	< 0.001
LMR	2.65 (1.72, 4.20)	1.81 (1.35, 3.27)	2.36 (1.58, 3.81)	3.11 (2.41, 4.72)	3.31 (2.18, 4.53)	< 0.001
CRP (mg/dL)	2.02 (0.77, 6.76)	3.58 (1.93, 9.13)	2.21 (1.10, 7.52)	1.20 (0.48, 2.68)	1.08 (0.43, 3.05)	< 0.001
Hb (g/dL)	115 (98, 132)	99 (84, 120)	110 (93, 121.5)	126 (113, 135.8)	127.5 (113, 139)	< 0.001
ESR (mm/hour)	21.5 (11, 41)	38 (20.5, 62)	31 (17, 49)	16 (9, 26.5)	12 (7, 27.75)	< 0.001
PA (mg/L)	164.7 (108.7, 217.7)	76.5 (58.8, 96.8)	137.7 (128, 152.8)	194.2 (175.27, 206.8)	247.4 (222.9, 262.3)	< 0.001
ALB (g/dL)	35 (30.1, 39.4)	30.1 (26.5, 36.5)	33.9 (30.4, 37.5)	36.6 (33.5, 40.1)	37.3 (32.8, 41.5)	< 0.001
Fg (g/L)	2.95 (2.79, 3.52)	3.24 (2.86, 3.83)	3.01 (2.81, 3.76)	2.88 (2.74, 3.20)	2.91 (2.71, 3.18)	< 0.001
D-dimer (mg/L)	0.51 (0.26, 1.08)	0.75 (0.35, 1.98)	0.81 (0.41, 1.39)	0.34 (0.20, 0.64)	0.33 (0.21, 0.62)	< 0.001
Crohn’s disease related
Montreal A classification						0.140
1	20 (7.1)	3 (4.2)	3 (4.2)	9 (12.9)	5 (7.1)
2	197 (69.9)	55 (77.5)	49 (69.0)	49 (70.0)	44 (62.9)
3	65 (23.0)	13 (18.3)	19 (26.8)	12 (17.1)	21 (30.0)
Montreal B classification						0.053
1	16 (5.7)	4 (5.6)	7 (9.9)	1 (1.4)	4 (5.7)
2	113 (40.1)	24 (33.8)	21 (29.6)	37 (52.9)	31 (44.3)
3	153 (54.3)	43 (60.6)	43 (60.6)	32 (45.7)	35 (50.0)
Montreal L classification						0.668
1	87 (30.9)	18 (25.4)	20 (28.2)	19 (27.1)	30 (42.9)
2	16 (5.7)	5 (7.0)	4 (5.6)	4 (5.7)	3 (4.3)
3	159 (56.4)	42 (59.2)	42 (59.2)	42 (60.0)	33 (47.1)
4	20 (7.1)	6 (8.5)	5 (7.0)	5 (7.1)	4 (5.7)
CDAI						0.011
Remission	74 (26.2)	9 (12.7)	20 (28.2)	19 (27.1)	26 (37.1)
Active	208 (73.8)	62 (87.3)	51 (71.8)	51 (72.9)	44 (62.9)
Perianal abscess						0.085
No	240 (85.1)	54 (76.1)	61 (85.9)	62 (88.6)	63 (90.0)
Yes	42 (14.9)	17 (23.9)	10 (14.1)	8 (11.4)	7 (10.0)
Preoperative use of drugs
5-aminosalicylic acid	83 (29.4)	20 (28.2)	17 (23.9)	26 (37.1)	20 (28.6)	0.282
Steroid	78 (27.7)	18 (25.4)	16 (22.5)	24 (34.3)	20 (28.6)	0.425
Immunosuppressant	105 (37.2)	24 (33.8)	30 (42.3)	28 (40.0)	23 (32.9)	0.624
Biological agent	103 (36.5)	26 (36.6)	23 (32.4)	25 (35.7)	29 (41.4)	0.737

Full Size Table

Table 3 Quantile regression analysis of the association between prealbumin and the risks of needing surgery and endoscopic recurrence

	Q1	Q2, HR (95%CI) P value	Q3, HR (95%CI) P value	Q4, HR (95%CI) P value	P for trend
Surgery
Model 1¹	Recurrence	0.45 (0.32-0.64), < 0.001	0.33 (0.23-0.48), < 0.001	0.25 (0.17-0.37), < 0.001	< 0.001
Model 2²	Recurrence	0.45 (0.32-0.63), < 0.001	0.32 (0.22-0.46), < 0.001	0.24 (0.16-0.35), < 0.001	< 0.001
Model 3³	Recurrence	0.50 (0.35-0.73), < 0.001	0.31 (0.20-0.47), < 0.001	0.20 (0.13-0.33), < 0.001	< 0.001
Recurrence
Model 4⁴	Recurrence	0.93 (0.60-1.45), 0.747	0.55 (0.34-0.89), 0.014	0.38 (0.23-0.61), < 0.001	< 0.001
Model 5⁵	Recurrence	0.94 (0.60-1.48), 0.789	0.49 (0.30-0.81), 0.005	0.34 (0.21-0.56), < 0.001	< 0.001
Model 6⁶	Recurrence	1.25 (0.75-2.07), 0.389	0.59 (0.33-1.05), 0.074	0.45 (0.26-0.80), 0.007	< 0.001

¹Model 1 was the crude model.

²Model 2 was adjusted for gender, body mass index, and smoking history.

³Model 3 was further adjusted for gender, body mass index, smoking history, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, C-reactive protein, haemoglobin, erythrocyte sedimentation rate, albumin, prothrombin time, fibrinogen, D-dimer, the Montreal A and B classifications, Crohn’s Disease Activity Index, perianal abscess, and the biological therapy.

⁴Model 4 was the crude model.

⁵Model 5 was adjusted for gender, age, body mass index, and smoking history.

⁶Model 6 was further adjusted for gender, age, body mass index, smoking history, white blood cells, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, albumin, fibrinogen, Crohn’s Disease Activity Index, perianal abscess, and preoperative-biologics.

HR: Hazard ratio; CI: Confidence interval.

Full Size Table

Table 4 Association between prealbumin levels and the risks of needing surgery and endoscopic recurrence based on segmented regression analysis

Model	Surgery, HR (95%CI), P value		Model	Recurrence, HR (95%CI), P value
Model	PA ≤ 208.149 mg/L	PA > 208.149 mg/L	Model	PA ≤ 148.816 mg/L	PA > 148.816 mg/L
Model 1¹	0.989 (0.986-0.993), < 0.001	0.997 (0.989-1.004), 0.380	Model 4⁴	0.999 (0.993-1.006), 0.849	0.993 (0.987-0.999), 0.035
Model 2²	0.989 (0.986-0.993), < 0.001	0.997 (0.989-1.004), 0.383	Model 5⁵	0.999 (0.993-1.005), 0.773	0.992 (0.996-0.999), 0.016
Model 3³	0.991 (0.987-0.995), < 0.001	0.997 (0.989-1.005), 0.483	Model 6⁶	1.002 (0.994-1.010), 0.593	0.988 (0.981-0.996), 0.001

¹Model 1 was the crude model.

²Model 2 was adjusted for gender, body mass index, and smoking history.

⁴Model 4 was the crude model.

⁵Model 5 was adjusted for gender, age, body mass index, and smoking history.

PA: Prealbumin; HR: Hazard ratio; CI: Confidence interval.

Full Size Table

Citation: Xie KL, Long G, Yuan LW, Zhang D. Association of prealbumin with risk of abdominal surgery and endoscopic recurrence in Crohn’s disease: A machine learning study. World J Gastroenterol 2026; 32(36): 119629
URL: https://www.wjgnet.com/1007-9327/full/v32/i36/119629.htm
DOI: https://dx.doi.org/10.3748/wjg.119629

Xie KL, Long G, Yuan LW, Zhang D. Association of prealbumin with risk of abdominal surgery and endoscopic recurrence in Crohn’s disease: A machine learning study. World J Gastroenterol 2026; 32(36): 119629 [DOI: 10.3748/wjg.119629]

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