Development of an index to define overall disease severity in IBD

Corey A. Siegel, Cynthia B. Whitman, Brennan M.R. Spiegel, Brian Feagan, Bruce Sands, Edward V. Loftus, Remo Panaccione, Geert D'Haens, Charles N. Bernstein, Richard Gearry, Siew C. Ng, Gerassimos J. Mantzaris, Balfour Sartor, Mark S. Silverberg, Robert Riddell, Ioannis E. Koutroubakis, Colm O'Morain, P. Lakatos, Dermot P.B. McGovern, Jonas HalfvarsonWalter Reinisch, Gerhard Rogler, Wolfgang Kruis, Curt Tysk, Stefan Schreiber, Silvio Danese, William Sandborn, Anne Griffiths, Bjorn Moum, Christoph Gasche, Francesco Pallone, Simon Travis, Julian Panes, Jean Frederic Colombel, Stephen Hanauer, Laurent Peyrin-Biroulet

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background and aim Disease activity for Crohn's disease (CD) and UC is typically defined based on symptoms at a moment in time, and ignores the long-term burden of disease. The aims of this study were to select the attributes determining overall disease severity, to rank the importance of and to score these individual attributes for both CD and UC. Methods Using a modified Delphi panel, 14 members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) selected the most important attributes related to IBD. Eighteen IOIBD members then completed a statistical exercise (conjoint analysis) to create a relative ranking of these attributes. Adjusted utilities were developed by creating proportions for each level within an attribute. Results For CD, 15.8% of overall disease severity was attributed to the presence of mucosal lesions, 10.9% to history of a fistula, 9.7% to history of abscess and 7.4% to history of intestinal resection. For UC, 18.1% of overall disease severity was attributed to mucosal lesions, followed by 14.0% for impact on daily activities, 11.2% C reactive protein and 10.1% for prior experience with biologics. Overall disease severity indices were created on a 100-point scale by applying each attribute's average importance to the adjusted utilities. Conclusions Based on specialist opinion, overall CD severity was associated more with intestinal damage, in contrast to overall UC disease severity, which was more dependent on symptoms and impact on daily life. Once validated, disease severity indices may provide a useful tool for consistent assessment of overall disease severity in patients with IBD.

Original languageEnglish
Pages (from-to)244-254
Number of pages11
JournalGut
Volume67
Issue number2
DOIs
Publication statusPublished - Feb 1 2018

Fingerprint

Crohn Disease
Inflammatory Bowel Diseases
Biological Products
C-Reactive Protein
Abscess
Fistula
Exercise

Keywords

  • CROHN'S DISEASE
  • IBD
  • ULCERATIVE COLITIS

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Siegel, C. A., Whitman, C. B., Spiegel, B. M. R., Feagan, B., Sands, B., Loftus, E. V., ... Peyrin-Biroulet, L. (2018). Development of an index to define overall disease severity in IBD. Gut, 67(2), 244-254. https://doi.org/10.1136/gutjnl-2016-312648

Development of an index to define overall disease severity in IBD. / Siegel, Corey A.; Whitman, Cynthia B.; Spiegel, Brennan M.R.; Feagan, Brian; Sands, Bruce; Loftus, Edward V.; Panaccione, Remo; D'Haens, Geert; Bernstein, Charles N.; Gearry, Richard; Ng, Siew C.; Mantzaris, Gerassimos J.; Sartor, Balfour; Silverberg, Mark S.; Riddell, Robert; Koutroubakis, Ioannis E.; O'Morain, Colm; Lakatos, P.; McGovern, Dermot P.B.; Halfvarson, Jonas; Reinisch, Walter; Rogler, Gerhard; Kruis, Wolfgang; Tysk, Curt; Schreiber, Stefan; Danese, Silvio; Sandborn, William; Griffiths, Anne; Moum, Bjorn; Gasche, Christoph; Pallone, Francesco; Travis, Simon; Panes, Julian; Colombel, Jean Frederic; Hanauer, Stephen; Peyrin-Biroulet, Laurent.

In: Gut, Vol. 67, No. 2, 01.02.2018, p. 244-254.

Research output: Contribution to journalArticle

Siegel, CA, Whitman, CB, Spiegel, BMR, Feagan, B, Sands, B, Loftus, EV, Panaccione, R, D'Haens, G, Bernstein, CN, Gearry, R, Ng, SC, Mantzaris, GJ, Sartor, B, Silverberg, MS, Riddell, R, Koutroubakis, IE, O'Morain, C, Lakatos, P, McGovern, DPB, Halfvarson, J, Reinisch, W, Rogler, G, Kruis, W, Tysk, C, Schreiber, S, Danese, S, Sandborn, W, Griffiths, A, Moum, B, Gasche, C, Pallone, F, Travis, S, Panes, J, Colombel, JF, Hanauer, S & Peyrin-Biroulet, L 2018, 'Development of an index to define overall disease severity in IBD', Gut, vol. 67, no. 2, pp. 244-254. https://doi.org/10.1136/gutjnl-2016-312648
Siegel CA, Whitman CB, Spiegel BMR, Feagan B, Sands B, Loftus EV et al. Development of an index to define overall disease severity in IBD. Gut. 2018 Feb 1;67(2):244-254. https://doi.org/10.1136/gutjnl-2016-312648
Siegel, Corey A. ; Whitman, Cynthia B. ; Spiegel, Brennan M.R. ; Feagan, Brian ; Sands, Bruce ; Loftus, Edward V. ; Panaccione, Remo ; D'Haens, Geert ; Bernstein, Charles N. ; Gearry, Richard ; Ng, Siew C. ; Mantzaris, Gerassimos J. ; Sartor, Balfour ; Silverberg, Mark S. ; Riddell, Robert ; Koutroubakis, Ioannis E. ; O'Morain, Colm ; Lakatos, P. ; McGovern, Dermot P.B. ; Halfvarson, Jonas ; Reinisch, Walter ; Rogler, Gerhard ; Kruis, Wolfgang ; Tysk, Curt ; Schreiber, Stefan ; Danese, Silvio ; Sandborn, William ; Griffiths, Anne ; Moum, Bjorn ; Gasche, Christoph ; Pallone, Francesco ; Travis, Simon ; Panes, Julian ; Colombel, Jean Frederic ; Hanauer, Stephen ; Peyrin-Biroulet, Laurent. / Development of an index to define overall disease severity in IBD. In: Gut. 2018 ; Vol. 67, No. 2. pp. 244-254.
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abstract = "Background and aim Disease activity for Crohn's disease (CD) and UC is typically defined based on symptoms at a moment in time, and ignores the long-term burden of disease. The aims of this study were to select the attributes determining overall disease severity, to rank the importance of and to score these individual attributes for both CD and UC. Methods Using a modified Delphi panel, 14 members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) selected the most important attributes related to IBD. Eighteen IOIBD members then completed a statistical exercise (conjoint analysis) to create a relative ranking of these attributes. Adjusted utilities were developed by creating proportions for each level within an attribute. Results For CD, 15.8{\%} of overall disease severity was attributed to the presence of mucosal lesions, 10.9{\%} to history of a fistula, 9.7{\%} to history of abscess and 7.4{\%} to history of intestinal resection. For UC, 18.1{\%} of overall disease severity was attributed to mucosal lesions, followed by 14.0{\%} for impact on daily activities, 11.2{\%} C reactive protein and 10.1{\%} for prior experience with biologics. Overall disease severity indices were created on a 100-point scale by applying each attribute's average importance to the adjusted utilities. Conclusions Based on specialist opinion, overall CD severity was associated more with intestinal damage, in contrast to overall UC disease severity, which was more dependent on symptoms and impact on daily life. Once validated, disease severity indices may provide a useful tool for consistent assessment of overall disease severity in patients with IBD.",
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AU - Whitman, Cynthia B.

AU - Spiegel, Brennan M.R.

AU - Feagan, Brian

AU - Sands, Bruce

AU - Loftus, Edward V.

AU - Panaccione, Remo

AU - D'Haens, Geert

AU - Bernstein, Charles N.

AU - Gearry, Richard

AU - Ng, Siew C.

AU - Mantzaris, Gerassimos J.

AU - Sartor, Balfour

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AU - Riddell, Robert

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AU - Griffiths, Anne

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AU - Gasche, Christoph

AU - Pallone, Francesco

AU - Travis, Simon

AU - Panes, Julian

AU - Colombel, Jean Frederic

AU - Hanauer, Stephen

AU - Peyrin-Biroulet, Laurent

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N2 - Background and aim Disease activity for Crohn's disease (CD) and UC is typically defined based on symptoms at a moment in time, and ignores the long-term burden of disease. The aims of this study were to select the attributes determining overall disease severity, to rank the importance of and to score these individual attributes for both CD and UC. Methods Using a modified Delphi panel, 14 members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) selected the most important attributes related to IBD. Eighteen IOIBD members then completed a statistical exercise (conjoint analysis) to create a relative ranking of these attributes. Adjusted utilities were developed by creating proportions for each level within an attribute. Results For CD, 15.8% of overall disease severity was attributed to the presence of mucosal lesions, 10.9% to history of a fistula, 9.7% to history of abscess and 7.4% to history of intestinal resection. For UC, 18.1% of overall disease severity was attributed to mucosal lesions, followed by 14.0% for impact on daily activities, 11.2% C reactive protein and 10.1% for prior experience with biologics. Overall disease severity indices were created on a 100-point scale by applying each attribute's average importance to the adjusted utilities. Conclusions Based on specialist opinion, overall CD severity was associated more with intestinal damage, in contrast to overall UC disease severity, which was more dependent on symptoms and impact on daily life. Once validated, disease severity indices may provide a useful tool for consistent assessment of overall disease severity in patients with IBD.

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