Validating Crohn's disease activity indices for use in assessing postoperative recurrence

Authors

  • T.D. Walters MD,

    1. Department of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
    2. Department of Pediatrics, Toronto, Ontario, Canada
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    • T.D.W. received combined Fellowship support from the Crohn's and Colitis Foundation of Canada, AstraZeneca Canada, the Canadian Institutes of Health Research, and the Canadian Association of Gastroenterology. Trial funded by the Canadian Institute for Health Research, the Crohn's and Colitis Foundation of America, and Ethicon Endosurgery. Sites Participating in the CAST trial used surgical staplers supplied by Ethicon Endosurgery. Beyond this, no author has any conflict of interest to disclose related to this article.

  • A.H. Steinhart MD,

    1. Zane Cohen Digestive Diseases Clinical Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • C.N. Bernstein MD,

    1. Department of Internal Medicine, University of Manitoba and the University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
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  • W. Tremaine MD,

    1. Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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  • M. McKenzie RN,

    1. Zane Cohen Digestive Diseases Clinical Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. Department of Surgery, Toronto, Ontario, Canada
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  • B.G. Wolff MD,

    1. Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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  • R.S. McLeod MD

    Corresponding author
    1. Department of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
    2. Zane Cohen Digestive Diseases Clinical Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
    3. Department of Surgery, Toronto, Ontario, Canada
    4. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
    • Room 449, Mount Sinai Hospital, 600 University Ave., Toronto, Ontario M5G 1X5, Canada
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  • Summarized findings from this study were presented in oral form at the 107th Annual Meeting of the AGA, Los Angeles, 2006.

Abstract

Background:

The Crohn's Disease Activity Index (CDAI) has been used in medical trials with scores <150 indicative of remission. Its value in assessing postoperative recurrence is unknown. The objective of this study was to explore the utility of the CDAI in determining the presence or absence of symptomatic disease recurrence in patients having previously undergone ileocolic resection for Crohn's disease.

Methods:

Ninety-three patients underwent clinical and colonoscopic evaluation within 12 months of ileocolic resection. Endoscopic appearance was assessed using the Rutgeerts score (i0–i4). Symptomatic disease recurrence was defined by the composite of symptom severity warranting therapy and an endoscopic score ≥i2. CDAI scores were calculated. Comparisons were made using the receiver operator curve (ROC).

Results:

Thirty-nine (42%) patients had recurrent disease (22% symptomatic, 20% endoscopic only) at 12 months. Median CDAI for symptomatic recurrence was 198 (interquartile range [IQR]: 106–293), 80 for asymptomatic subjects (IQR 35–115). The area under the ROC curve for symptomatic disease and CDAI was 0.78 (95% confidence interval [CI] 0.64–0.91). Recurrence was best predicted by a CDAI of ≥148 (sensitivity 70%, specificity 81%). A strong linear relationship existed between the CDAI and Inflammatory Bowel Disease Questionnaire (r = 0.82).

Conclusions:

The CDAI performs reasonably well in the postoperative setting and 150 appears the best cutpoint for indicating symptomatic disease. However, it is likely not suitable for use as the primary outcome measure. These data suggest that a combination of symptom assessment plus endoscopic evidence of recurrence should remain the gold standard definition for assessing outcomes in postoperative CD trials. (Inflamm Bowel Dis 2010;)

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