The disease severity index for inflammatory bowel disease is a valid instrument that predicts complicated disease

Akhilesh Swaminathan; James M. Fulforth; Chris M. Frampton; Grace M. Borichevsky; Thomas C. Mules; Kate Kilpatrick; Myriam Choukour; Peter Fields; Resham Ramkissoon; Emily Helms; Stephen B. Hanauer; Rupert W. Leong; Laurent Peyrin-Biroulet; Corey A Siegel; Richard B. Gearry

doi:10.1093/ibd/izad294

The disease severity index for inflammatory bowel disease is a valid instrument that predicts complicated disease

Akhilesh Swaminathan, James M. Fulforth, Chris M. Frampton, Grace M. Borichevsky, Thomas C. Mules, Kate Kilpatrick, Myriam Choukour, Peter Fields, Resham Ramkissoon, Emily Helms, Stephen B. Hanauer, Rupert W. Leong, Laurent Peyrin-Biroulet, Corey A Siegel, Richard B. Gearry

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course.

Methods: A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach's alpha measured internal consistency of DSI items. Spearman's rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression.

Results: Three hundred and sixty-nine participants were included (Crohn's disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa > 0.4) and internal consistency (CD, α > 0.59; UC, α > 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P < .001; UCn=105, r = 0.80, P < .001), symptoms (CDn=159, r = 0.69, P < .001; UCn=132, r = 0.58, P < .001), quality of life (CDn=198, r = -0.59, P < .001; UCn=128, r = -0.68, P < .001), and disability (CDn=83, r = -0.67, P < .001; UCn=52, r = -0.74, P < .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P < .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49).

Conclusions: The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.

Original language	English
Pages (from-to)	2064-2075
Number of pages	12
Journal	Inflammatory Bowel Diseases
Volume	30
Issue number	11
Early online date	22 Dec 2023
DOIs	https://doi.org/10.1093/ibd/izad294
Publication status	Published - 4 Nov 2024
Externally published	Yes

Bibliographical note

Copyright the Crohn’s & Colitis Foundation 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

inflammatory bowel disease
outcomes research
symptom score or index

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10.1093/ibd/izad294Licence: CC BY-NC

Publisher version (open access)Final published version, 15.2 MBLicence: CC BY-NC

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Swaminathan, A., Fulforth, J. M., Frampton, C. M., Borichevsky, G. M., Mules, T. C., Kilpatrick, K., Choukour, M., Fields, P., Ramkissoon, R., Helms, E., Hanauer, S. B., Leong, R. W., Peyrin-Biroulet, L., Siegel, C. A., & Gearry, R. B. (2024). The disease severity index for inflammatory bowel disease is a valid instrument that predicts complicated disease. Inflammatory Bowel Diseases, 30(11), 2064-2075. https://doi.org/10.1093/ibd/izad294

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title = "The disease severity index for inflammatory bowel disease is a valid instrument that predicts complicated disease",

abstract = "Background: The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course.Methods: A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach's alpha measured internal consistency of DSI items. Spearman's rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression.Results: Three hundred and sixty-nine participants were included (Crohn's disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa > 0.4) and internal consistency (CD, α > 0.59; UC, α > 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P < .001; UCn=105, r = 0.80, P < .001), symptoms (CDn=159, r = 0.69, P < .001; UCn=132, r = 0.58, P < .001), quality of life (CDn=198, r = -0.59, P < .001; UCn=128, r = -0.68, P < .001), and disability (CDn=83, r = -0.67, P < .001; UCn=52, r = -0.74, P < .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P < .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49).Conclusions: The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.",

keywords = "inflammatory bowel disease, outcomes research, symptom score or index",

author = "Akhilesh Swaminathan and Fulforth, {James M.} and Frampton, {Chris M.} and Borichevsky, {Grace M.} and Mules, {Thomas C.} and Kate Kilpatrick and Myriam Choukour and Peter Fields and Resham Ramkissoon and Emily Helms and Hanauer, {Stephen B.} and Leong, {Rupert W.} and Laurent Peyrin-Biroulet and Siegel, {Corey A} and Gearry, {Richard B.}",

note = "Copyright the Crohn{\textquoteright}s & Colitis Foundation 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2024",

month = nov,

day = "4",

doi = "10.1093/ibd/izad294",

language = "English",

volume = "30",

pages = "2064--2075",

journal = "Inflammatory Bowel Diseases",

issn = "1078-0998",

publisher = "John Wiley & Sons",

number = "11",

}

Swaminathan, A, Fulforth, JM, Frampton, CM, Borichevsky, GM, Mules, TC, Kilpatrick, K, Choukour, M, Fields, P, Ramkissoon, R, Helms, E, Hanauer, SB, Leong, RW, Peyrin-Biroulet, L, Siegel, CA & Gearry, RB 2024, 'The disease severity index for inflammatory bowel disease is a valid instrument that predicts complicated disease', Inflammatory Bowel Diseases, vol. 30, no. 11, pp. 2064-2075. https://doi.org/10.1093/ibd/izad294

TY - JOUR

T1 - The disease severity index for inflammatory bowel disease is a valid instrument that predicts complicated disease

AU - Swaminathan, Akhilesh

AU - Fulforth, James M.

AU - Frampton, Chris M.

AU - Borichevsky, Grace M.

AU - Mules, Thomas C.

AU - Kilpatrick, Kate

AU - Choukour, Myriam

AU - Fields, Peter

AU - Ramkissoon, Resham

AU - Helms, Emily

AU - Hanauer, Stephen B.

AU - Leong, Rupert W.

AU - Peyrin-Biroulet, Laurent

AU - Siegel, Corey A

AU - Gearry, Richard B.

N1 - Copyright the Crohn’s & Colitis Foundation 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2024/11/4

Y1 - 2024/11/4

N2 - Background: The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course.Methods: A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach's alpha measured internal consistency of DSI items. Spearman's rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression.Results: Three hundred and sixty-nine participants were included (Crohn's disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa > 0.4) and internal consistency (CD, α > 0.59; UC, α > 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P < .001; UCn=105, r = 0.80, P < .001), symptoms (CDn=159, r = 0.69, P < .001; UCn=132, r = 0.58, P < .001), quality of life (CDn=198, r = -0.59, P < .001; UCn=128, r = -0.68, P < .001), and disability (CDn=83, r = -0.67, P < .001; UCn=52, r = -0.74, P < .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P < .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49).Conclusions: The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.

AB - Background: The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course.Methods: A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach's alpha measured internal consistency of DSI items. Spearman's rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression.Results: Three hundred and sixty-nine participants were included (Crohn's disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa > 0.4) and internal consistency (CD, α > 0.59; UC, α > 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P < .001; UCn=105, r = 0.80, P < .001), symptoms (CDn=159, r = 0.69, P < .001; UCn=132, r = 0.58, P < .001), quality of life (CDn=198, r = -0.59, P < .001; UCn=128, r = -0.68, P < .001), and disability (CDn=83, r = -0.67, P < .001; UCn=52, r = -0.74, P < .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P < .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49).Conclusions: The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.

KW - inflammatory bowel disease

KW - outcomes research

KW - symptom score or index

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U2 - 10.1093/ibd/izad294

DO - 10.1093/ibd/izad294

M3 - Article

C2 - 38134391

SN - 1078-0998

VL - 30

SP - 2064

EP - 2075

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

IS - 11

ER -

The disease severity index for inflammatory bowel disease is a valid instrument that predicts complicated disease

Abstract

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