title: Development of an index to define overall disease severity in IBD.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors: Corey A
authors: CA
authors: Siegel
authors: Department of Health Services, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Cynthia B
authors: CB
authors: Whitman
authors: Department of Health Services, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Brennan M R
authors: BMR
authors: Spiegel
authors: Robarts Clinical Trials, London, Ontario, Canada.
authors: Brian
authors: B
authors: Feagan
authors: Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors: Bruce
authors: B
authors: Sands
authors: Mayo Clinic, Rochester, Minnesota, USA.
authors: Edward V
authors: EV
authors: Loftus
authors: University of Calgary, Calgary, Alberta, Canada.
authors: Remo
authors: R
authors: Panaccione
authors: Academic Medical Center, Amsterdam, Netherlands.
authors: Geert
authors: G
authors: D'Haens
authors: University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Charles N
authors: CN
authors: Bernstein
authors: University of Otago, Christchurch, New Zealand.
authors: Richard
authors: R
authors: Gearry
authors: Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors: Siew C
authors: SC
authors: Ng
authors: Evangelismos-PolyCliniki-Ophthalmiatreion Hospital, Athens, Greece.
authors: Gerassimos J
authors: GJ
authors: Mantzaris
authors: University of North Carolina, Chapel Hill, North Carolina, USA.
authors: Balfour
authors: B
authors: Sartor
authors: Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Mark S
authors: MS
authors: Silverberg
authors: Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Robert
authors: R
authors: Riddell
authors: University Hospital Heraklion, Crete, Greece.
authors: Ioannis E
authors: IE
authors: Koutroubakis
authors: Faculty of Health Sciences Trinity College Dublin, Dublin, Ireland.
authors: Colm
authors: C
authors: O'Morain
authors: Semmelweis University, Budapest, Hungary.
authors: Peter L
authors: PL
authors: Lakatos
authors: Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Dermot P B
authors: DPB
authors: McGovern
authors: Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors: Jonas
authors: J
authors: Halfvarson
authors: McMaster University, Hamilton, Ontario, Canada.
authors: Walter
authors: W
authors: Reinisch
authors: University Hospital of Zuürich, Zurich, Switzerland.
authors: Gerhard
authors: G
authors: Rogler
authors: University of Cologne, Koln, Germany.
authors: Wolfgang
authors: W
authors: Kruis
authors: Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors: Curt
authors: C
authors: Tysk
authors: University Hopital Schleswig Holstein, Kiel, Germany.
authors: Stefan
authors: S
authors: Schreiber
authors: Humanitas University, Milan, Italy.
authors: Silvio
authors: S
authors: Danese
authors: UCSD, San Diego, California, USA.
authors: William
authors: W
authors: Sandborn
authors: Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Anne
authors: A
authors: Griffiths
authors: Oslo University Hospital and University Oslo, Oslo, Norway.
authors: Bjorn
authors: B
authors: Moum
authors: Medical University and General Hospital Vienna, Vienna, Austria.
authors: Christoph
authors: C
authors: Gasche
authors: University of Rome Tor Vergata, Rome, Italy.
authors: Francesco
authors: F
authors: Pallone
authors: Oxford University Hospital, Oxford, UK.
authors: Simon
authors: S
authors: Travis
authors: Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors: Julian
authors: J
authors: Panes
authors: Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors: Jean-Frederic
authors: JF
authors: Colombel
authors: Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.
authors: Stephen
authors: S
authors: Hanauer
authors: Inserm U954 and CHU de Nancy, Lorraine University, Nancy, France.
authors: Laurent
authors: L
authors: Peyrin-Biroulet
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001688:Biological Products / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D003697:Delphi Technique; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology*; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D063189:Symptom Assessment
chemical_list: D001688:Biological Products; D002097:C-Reactive Protein
keywords: CROHN'S DISEASE; IBD; ULCERATIVE COLITIS