Department of Medicine, University of Otago, Christchurch, New Zealand.
Department of Gastroenterology, Christchurch Hospital, New Zealand.
Inflamm Bowel Dis. 2024 Nov 4;30(11):2064-2075. doi: 10.1093/ibd/izad294.
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.
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.
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).
The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.
炎症性肠病（IBD）的疾病严重程度指数（DSI）综合了疾病表型、炎症活动度和患者报告的结果的测量。我们旨在验证 DSI 并评估其在预测复杂 IBD 病程中的效用。
我们招募了一个多中心的成年 IBD 患者队列。组内相关系数（ICCs）和加权 Kappa 评估了评分者间的可靠性。克朗巴赫的 alpha 测量了 DSI 项目的内部一致性。Spearman 秩相关比较了 DSI 与内镜指数、症状指数、生活质量和残疾的相关性。一个亚组进行了 24 个月的随访，以评估复杂的 IBD 病程。接受者操作特征曲线（AUROC）下面积和多变量逻辑回归评估了 DSI 在预测疾病进展方面的效用。
共纳入 369 名参与者（克罗恩病 [CD]，n=230；女性，n=194；平均年龄 46 岁[标准差，15]；中位疾病持续时间，11 年[四分位间距，5-21]），其中 171 名（CD，n=99；溃疡性结肠炎 [UC]，n=72）进行了前瞻性随访。DSI 对 CD（ICC 0.93，n=65）和 UC（ICC 0.97，n=33）具有评分者间可靠性。DSI 项目表现出评分者间一致性（Kappa＞0.4）和内部一致性（CD，α＞0.59；UC，α＞0.75）。DSI 与内镜活动度（CDn=141，r=0.65，P＜0.001；UCn=105，r=0.80，P＜0.001）、症状（CDn=159，r=0.69，P＜0.001；UCn=132，r=0.58，P＜0.001）、生活质量（CDn=198，r=-0.59，P＜0.001；UCn=128，r=-0.68，P＜0.001）和残疾（CDn=83，r=-0.67，P＜0.001；UCn=52，r=-0.74，P＜0.001）显著相关。DSI 为 23 时可最佳预测复杂 IBD 病程（AUROC=0.82，P＜0.001），并在多变量分析中与该终点相关（比值比，9.20；95%置信区间，3.32-25.49）。
DSI 可靠地包含了导致疾病严重程度的因素，并准确地预测了 IBD 的纵向病程。
