A prospective observational cohort study demonstrated that the IBD-disk, a visual self-administered patient-reported outcome measure, can predict adverse treatment outcomes during the first year following inflammatory bowel disease diagnosis—while simultaneously screening for clinically significant depression and anxiety symptoms.

In the study, conducted at University Hospitals Birmingham National Health Service (NHS) Foundation Trust between February 2021 and June 2024, researchers enrolled 188 patients (97 with Crohn's disease [CD] and 91 with ulcerative colitis [UC]) who completed baseline IBD-disk assessments prior to diagnosis confirmation.

Elevated baseline disk scores in UC predicted the subsequent need for advanced therapies, persistent active disease at 12 months, and the need for inpatient treatment. In CD, elevated scores similarly predicted the need for advanced therapies and persistent active disease; however, the association with surgical resection within 12 months didn't reach statistical significance.

For psychological symptom screening, the IBD-disk "Emotions" domain demonstrated strong correlation with Hospital Anxiety and Depression Scale (HADS) scores for both depression and anxiety. An "Emotions" domain score of 7 or greater identified all patients meeting the HADS threshold for moderate-to-severe depression.

"For the first time we have demonstrated that disability determined by the IBD-disk can help identify both [patients with] UC and CD at an increased risk [of] adverse treatment outcomes in the first 12 months after diagnosis," wrote lead study author Peter Rimmer, MD, of the Department of Gastroenterology at the University Hospitals Birmingham NHS Foundation Trust, and colleagues.

Study Design and Population

The researchers triaged patients to a dedicated rapid-access clinic based on symptoms compatible with inflammatory bowel disease (IBD) and elevated fecal calprotectin levels without mandated threshold. Patients completed the IBD-disk during the first outpatient appointment prior to diagnosis establishment. A subgroup of 95 patients (45 with CD and 50 with UC) completed simultaneous HADS assessments. Follow-up disk scores were collected posttreatment at a median of 117 days from 82 patients, with 37 completing paired posttreatment HADS.

The CD cohort demonstrated a higher prevalence of preexisting mental health disorders compared with the UC cohort (22% vs 11%). Depression, anxiety disorder, and mixed anxiety-depression accounted for 73% of all preexisting mental health diagnoses.

Overall IBD-disk scores were higher in patients subsequently diagnosed with CD (median = 56) compared with those diagnosed with UC (median = 45). This elevation was driven by statistically significant higher scores in the "Abdominal pain," "Interpersonal interactions," "Energy," "Emotions," and "Body image" domains.

Outcome Prediction and Clinical Utility

Complete 12-month outcome data were available among 179 patients (95 with CD and 84 with UC). In the UC cohort, the IBD-disk predicted advanced therapy requirement within 12 months, persistent active disease, and inpatient care requirement. Notably, among 84 patients with UC, the median IBD-disk score at baseline was 40 in those who didn't require admission vs 67 in those who did.

In the CD cohort, the disk similarly predicted the need for advanced therapy and persistent active disease. Among the small cohort requiring bowel resection surgery, the disk was more able to identify these patients compared with the Harvey-Bradshaw index. Nonetheless, this finding didn't reach statistical significance.

Patients with CD and preexisting mental health disorders received more oral corticosteroid courses during the first year (median = two vs one), though they were no more likely to have ongoing disease activity at 12 months, progress to advanced therapy, or require inpatient care.

Psychological Symptom Screening

Binomial logistic regression adjusting for age, sex, preexisting mental health diagnosis, hemoglobin, C-reactive protein, and baseline fecal calprotectin confirmed the independent predictive capacity of the "Emotions" domain. For moderate depression scores, this domain was the only independently significant predictor, with patients having nearly three times the risk of moderate-to-severe depression for each 1-point increase in the domain score. For moderate anxiety, the "Emotions" domain remained the sole independent predictor.

Posttreatment screening accuracy declined. The "Emotions" threshold of 7 or greater demonstrated inferior performance following diagnosis, with57% sensitivity and 70% specificity for both depression and anxiety outcomes.

Stratification by disease activity at follow-up revealed that patients with active disease maintained statistically significant higher HADS scores compared with those in remission (HADS anxiety: active median = 8, inactive median = 6; HADS depression: active median = 8, inactive median = 3). IBD-disk total scores demonstrated parallel findings (active median = 55, inactive median = 27).

Symptom Duration and Disease Correlates

Longer prediagnosis symptom duration positively correlated with overall IBD-disk scores. Patients with "Emotions" domain scores of 7 or greater had statistically significant longer symptom duration compared with those below the threshold (median = 9.5 vs 5 months), a finding more pronounced in those with CD (median 18 vs 6 months). Preexisting mental health disorders didn't associate with diagnostic delay in either the CD or UC cohorts.

In those with UC, total IBD-disk scores correlated with referral fecal calprotectin and endoscopic severity at diagnosis. These correlations weren't observed in the CD cohort.

Limitations and Clinical Implications

The researchers acknowledged key limitations, including single-center derivation, nonprotocolized treatment, substantial attrition in the longitudinal cohort limiting posttreatment validation, and an absence of socioeconomic confounding data. "While overall predictive capacity was not superior to traditional disease activity indices, our data supports the complementary role of the IBD-disk as a PROM at IBD diagnosis across disease subtypes," Dr. Rimmer and colleagues noted.

The researchers recommend that "alongside these established markers, higher IBD-disk scores at presentation should prompt consideration of a more aggressive therapeutic approach with earlier treatment escalation." They further suggested that "use of the IBD-disk during longitudinal follow-up may help identify those with a persisting psychological symptom burden beyond that attributable to disease activity alone."

Regarding screening utility, the researchers concluded: "While it is acknowledged that obtaining disk scores when diagnostic uncertainty remained may have heightened factors such as anxiety, our approach allowed for the quantification of baseline disease associated disability prior to any treatment being commenced and uninfluenced by any preconceptions about a given IBD type."

Disclosures can be found in the published study.

Source: Frontiers in Gastroenterology