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Validation of a Simple 0 to 10 Numerical Score (IBD-10) of Patient-reported Inflammatory Bowel Disease Activity for Routine Clinical Use

Subramanian, Sreedhar MBBS, MD*; Asher, Rebecca MSc; Weston, William MSc, MBChB*; Rimmer, Michael MBChB, MRes*; McConville, Adam MBChB*; Malin, Alex MBChB*; Jackson, Richard PhD; Collins, Paul MBBCh, MD*; Probert, Chris MBChB, MD; Dibb, Martyn MBChB, MD*; Rhodes, Jonathan M. MD

doi: 10.1097/MIB.0000000000000803
Original Clinical Articles

Background: Various physician- and patient-reported instruments exist for quantification of disease activity in inflammatory bowel diseases (IBD) but none are widely used in routine clinical practice. A simple patient-reported outcome measure might help inform clinical decision making. We evaluated a patient-reported 0 to 10 score of IBD activity (IBD-10) by correlation with conventional multicomponent activity indices.

Methods: A single-center prospective cross-sectional study was conducted in ambulant patients with IBD. Patients were asked to verbally rate the control of Crohn's disease (CD) or ulcerative colitis (UC) on a numerical scale from 0 to 10, with 10 indicating perfect control. Disease activity was assessed using Harvey–Bradshaw index for CD and simple clinical colitis activity index for UC.

Results: A total of 405 patients were included, of whom 209 (52%) had CD and 196 (48%) had UC. The median age was 41 (interquartile range, 27–55) years. IBD-10 correlated well with Harvey–Bradshaw Index (r s = −0.69, P < 0.001) and simple clinical colitis activity index (r s = −0.79, P < 0.001). An IBD-10 score of ≥7 predicted remission (defined by Harvey–Bradshaw index/simple clinical colitis activity index) with 90% sensitivity (95% confidence interval [CI], 86–94) and 75% specificity (95% CI, 67–82). The discriminatory ability of IBD-10 for remission was better for UC (area under the receiver operating characteristic curve, 0.93; 95% CI, 0.89–0.97) than for CD (area under the receiver operating characteristic curve, 0.86; 95% CI, 0.81–0.91; P = 0.035). An IBD-10 score of <7 correlated with treatment escalation.

Conclusions: The IBD-10 score correlates well with more complex clinical activity indices. Correlation was less strong for CD than for UC, possibly reflecting a weaker link in CD between stool frequency and the patient perspective of disease activity. The IBD-10 score could readily be used in routine clinical practice.

*Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom;

Cancer Research UK, Liverpool Cancer Trials Unit, Liverpool, United Kingdom; and

Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.

Reprints: Sreedhar Subramanian, MBBS, MD, Department of Gastroenterology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom (e-mail: sreedhar.subramanian@rlbuht.nhs.uk).

Author disclosures are available in the Acknowledgments.

Received January 24, 2016

Accepted February 9, 2016

© Crohn's & Colitis Foundation
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