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. 2022 Aug;56(4):664-674.
doi: 10.1111/apt.17058. Epub 2022 May 27.

The disease severity index for inflammatory bowel disease is associated with psychological symptoms and quality of life, and predicts a more complicated disease course

Akhilesh Swaminathan  1   2 , Dali Fan  2 , Grace M Borichevsky  1 , Thomas C Mules  2 , Esther Hirschfeld  1 , Chris M Frampton  1 , Andrew S Day  3 , Corey A Siegel  4 , Richard B Gearry  1   2
Affiliations

The disease severity index for inflammatory bowel disease is associated with psychological symptoms and quality of life, and predicts a more complicated disease course

Akhilesh Swaminathan et al. Aliment Pharmacol Ther. 2022 Aug.

Abstract

Background: The Disease Severity Index (DSI) is a novel tool to predict disease severity in inflammatory bowel disease (IBD). However, its ability to predict disease complications and the presence of psychosocial comorbidity is unclear.

Aims: To assess prospectively associations between the DSI and psychological symptoms, quality-of-life (QoL) and disease outcomes in an IBD cohort.

Methods: Patients with IBD undergoing ileocolonoscopy were followed prospectively for 12 months. DSI, psychological symptoms (perceived stress (PSS-10), depression (PHQ-9), anxiety (GAD-7)) and QoL (IBDQ-32) scores were assessed at baseline. Logistic regression identified variables predicting a complicated IBD course at 12 months (composite outcome of need for escalation of biological/immunomodulator for disease relapse, recurrent corticosteroid use, IBD-related hospitalisation and surgery). Receiver operating characteristics (ROC) analysis identified optimal DSI thresholds predicting a complicated disease course and multivariable logistic regression assessed the risk of reaching this outcome.

Results: One hundred and seventy-two patients were recruited (100 Crohn's disease, 91 female). Median DSI was 21 (IQR 11-32) and 97 patients had endoscopically active disease at baseline. The DSI was significantly higher in patients with symptoms of moderate-severe stress (PSS-10 > 14, p < 0.01), depression (PHQ-9 ≥ 10, p < 0.01), anxiety (GAD-7 ≥ 10, p < 0.05) and impaired quality-of-life (IBDQ-32 < 168, p < 0.01). Only the baseline DSI (OR 1.05, p < 0.01) and endoscopically active disease (OR 6.12, p < 0.01) were associated with a complicated IBD course. A DSI > 23 was strongly predictive of a complicated IBD course (OR 8.31, p < 0.001).

Conclusions: The DSI is associated with psychological distress, impaired QoL and predicts a more complicated disease course in patients with IBD.

Keywords: disease severity IBD; prognosis IBD; quality of life IBD.

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Conflict of interest statement

A.S. has received honoraria for educational activities for Janssen (unrelated to this manuscript). A.S.D. has served on advisory boards for Janssen, Abbvie and Nestle (all unrelated to this manuscript). C.A.S. has received personal fees as a consultant to Abbive, BMS, Lilly, Janssen, Pfizer, Prometheus, Takeda, Trellus Health; speaker fees for activities sponsored by Abbvie, Janssen, Pfizer, Takeda; grant support from Crohn's and Colitis Foundation: Leona M. and Harry B. Helmsley Charitable Trust, Abbvie, Janssen, Pfizer and Takeda (all unrelated to this manuscript). C.A.S. has equity interest as a co‐founder of MiTest health, LLC (software company). Technology developed by MiTest Health, LLC has been licensed to Takeda (unrelated to this manuscript). R.B.G. has received research grants, served on advisory boards and received honoraria for educational activities for Janssen, AbbVie and Zespri (unrelated to this manuscript).

Figures

FIGURE 1
FIGURE 1
The disease severity index (DSI) was associated with the presence of symptoms of significant stress (A, perceives stress scale, PSS‐10), depression (B, patient health questionnaire, PHQ‐9), anxiety (C, generalised anxiety disorder scale, GAD‐7) and impaired quality of life (D, inflammatory bowel diseases questionnaire, IBDQ‐32) at baseline. *p < 0.05, **p < 0.01, ***p < 0.001.
FIGURE 2
FIGURE 2
The disease severity index (DSI) accurately predicts for individuals who develop a complicated IBD course at 12 months (A) and a baseline DSI > 23 was associated with a significant increase in risk of developing a complicated IBD course at 12 months (B).
FIGURE 3
FIGURE 3
Degree of baseline inflammatory bowel disease (IBD) endoscopic disease activity stratified by baseline disease severity index (DSI) > 23< (A). Amongst individuals with inactive or mildly active disease at baseline, an elevated DSI >23 was associated with a significant increase in risk of developing a complicated IBD course at 12 months (B). Inactive IBD = simple endoscopic score for Crohn's disease (SES‐CD) < 3 or ulcerative colitis endoscopic index of severity (UCEIS) < 2. Mild IBD = SES‐CD < 7, UCEIS < 5. Moderate–severe IBD = SES‐CD ≥ 7, UCEIS ≥ 5.
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References

    1. Chang JT. Pathophysiology of inflammatory bowel diseases. N Engl J Med. 2020;383(27):2652–64. 10.1056/NEJMra2002697 - DOI - PubMed
    1. Verstockt B, Bressler B, Martinez‐Lozano H, McGovern D, Silverberg MS. Time to revisit disease classification in IBD: is the current classification of IBD good enough for optimal clinical management? Gastroenterology. 2022;162:1370–82. 10.1053/j.gastro.2021.12.246 - DOI - PubMed
    1. Verstockt B, Parkes M, Lee J. How do we predict a patient's disease course and whether they will respond to specific treatments? Gastroenterology. 2022;162:1383–95. 10.1053/j.gastro.2021.12.245 - DOI - PubMed
    1. Wintjens DSJ, de Jong MJ, van der Meulen‐de Jong AE, Romberg‐Camps MJ, Becx MC, Maljaars JP, et al. Novel perceived stress and life events precede flares of inflammatory bowel disease: a prospective 12‐month follow‐up study. J Crohns Colitis. 2019;13(4):410–6. 10.1093/ecco-jcc/jjy177 - DOI - PubMed
    1. Ananthakrishnan AN, Gainer VS, Perez RG, Cai T, Cheng SC, Savova G, et al. Psychiatric co‐morbidity is associated with increased risk of surgery in Crohn's disease. Aliment Pharmacol Ther. 2013;37(4):445–54. 10.1111/apt.12195 - DOI - PMC - PubMed

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