{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:22:21Z","timestamp":1787008941012,"version":"build-2736575974"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Key-Area Research and Development Program of Guangdong Province","award":["2023B1111040003"],"award-info":[{"award-number":["2023B1111040003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ulcerative colitis (UC) exhibits a heterogeneous clinical course, complicating prognostication and therapeutic decision making. Current tools inadequately predict progression or identify patients most likely to benefit from biologic therapies. We aimed to develop a machine learning model for risk stratification and evaluate its utility in optimizing biologic therapy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this multicenter retrospective study, we analyzed 481 UC patients as the training cohort and 131 external validation patients. Disease progression\u2014defined as treatment escalation, UC-related hospitalization, or surgery\u2014served as the primary endpoint. Four models (Cox regression, logistic regression, random forest, XGBoost) were developed to predict progression risk. Biologic-treated patients (n\u2009=\u2009235) were stratified into risk groups using the optimal model, with outcomes including mucosal healing, relapse, and acute severe UC assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The random forest model demonstrated superior performance, achieving an area under the curve of 0.959 in training set and 0.759 in validation set. High-risk biologic-treated patients (n\u2009=\u2009172) exhibited lower mucosal healing rates (33.7% vs 55.2%; P\u2009=\u2009.049) and higher hazards of clinical relapse (hazard ratio [HR], 3.35; P\u2009=\u2009.003), hospitalization (HR, 2.03; P\u2009=\u2009.014), and acute severe UC (HR, 2.70; P\u2009=\u2009.030) compared with low-risk patients (n\u2009=\u200963). No differences in serological remission, surgery, or biologic switching were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our random forest model enables precise risk stratification in UC, distinguishing patients with divergent responses to biologics. Low-risk patients derive significant benefit from timely biologics, while high-risk subgroups may require intensified strategies. This framework advances personalized UC management, though prospective validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ibd\/izaf272","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T11:29:04Z","timestamp":1760959744000},"page":"650-660","source":"Crossref","is-referenced-by-count":1,"title":["Risk-Stratified Biologic Efficacy in Ulcerative Colitis: A Multicenter Machine Learning Study"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9064-9174","authenticated-orcid":false,"given":"Pingxin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]},{"name":"Department of Gastroenterology, Zhongnan Hospital of Wuhan University , Wuhan, Hubei,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuhan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zishan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liru","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengyuan","family":"Su","sequence":"additional","affiliation":[{"name":"Institute of Precision Medicine, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zicheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1190-0325","authenticated-orcid":false,"given":"Shixian","family":"Hu","sequence":"additional","affiliation":[{"name":"Institute of Precision Medicine, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4173-2147","authenticated-orcid":false,"given":"Rui","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6836-9037","authenticated-orcid":false,"given":"Yun","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8181-0846","authenticated-orcid":false,"given":"Minhu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["China"]},{"name":"Department of Gastroenterology, Zhongnan Hospital of Wuhan University , Wuhan, Hubei,","place":["China"]},{"name":"Department of Gastroenterology, Shenzhen Qianhai Taikang Hospital , Shenzhen, Guangdong,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"2026040214065582600_izaf272-B1","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1016\/S0140-6736(16)32126-2","article-title":"Ulcerative colitis","volume":"389","author":"Ungaro","year":"2017","journal-title":"Lancet"},{"key":"2026040214065582600_izaf272-B2","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0140-6736(23)00966-2","article-title":"Ulcerative colitis","volume":"402","author":"Le Berre","year":"2023","journal-title":"Lancet"},{"key":"2026040214065582600_izaf272-B3","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1053\/j.gastro.2021.07.042","article-title":"Extraintestinal manifestations of 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