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Investigating Intestinal Inflammation in DSS-induced Model of IBD
Published on: February 1, 2012
Validation of claims-based indicators used to identify flare-ups in inflammatory bowel disease
Johan Burisch1, He Zhang2, Casey Kar-Chan Choong3
1Gastrounit, Medical Division, Hvidovre University Hospital, Kettegårdsalle 30, Capital Region, 2650, Denmark.
Insights
This study developed and validated administrative claims-based indicators to identify inflammatory bowel disease (IBD) flare-ups using Danish registry data. These indicators, including hospitalizations and treatments, effectively predict disease worsening in adults with Crohn's disease and ulcerative colitis.
Area of Science:
- Gastroenterology
- Health Informatics
- Epidemiology
Background:
- No validated claims-based indicators exist for identifying worsening inflammatory bowel disease (IBD).
- Developing such indicators is crucial for monitoring disease activity and patient outcomes.
- Danish nationwide registries offer a valuable data source for this research.
Purpose of the Study:
- To develop and validate claims-based indicators for identifying IBD flare-ups.
- To assess the predictive ability of these indicators using faecal calprotectin levels.
- To differentiate disease activity in Crohn's disease (CD) and ulcerative colitis (UC).
Main Methods:
- Utilized Danish nationwide administrative data from 2015-2017.
- Included patients with CD or UC with at least one faecal calprotectin measurement.
- Tested claims-based indicators against faecal calprotectin levels (<250 mg/kg, 250-1000 mg/kg, ≥1000 mg/kg) using generalized estimating equations.
Main Results:
- Included 890 children/4719 adults with CD and 592 children/5467 adults with UC.
- Identified key indicators for adult flare-ups: hospitalization, surgery, biologic therapy, systemic steroids, colonoscopy, and advanced imaging.
- Predictive ability of indicator combinations ranged from 0.62-0.67; fewer indicators were significant in children.
Conclusions:
- Administrative claims data are effective for identifying IBD flare-ups defined by faecal calprotectin.
- Clinically relevant events in the Danish national patient registry correlate with increased calprotectin and disease activity.
- Validated indicators can serve as robust outcomes in future IBD research.
Background & Aims:
There are currently no validated claims-based indicators for identifying a worsening of disease in patients with inflammatory bowel disease (IBD). Therefore, we aimed to develop and validate indicators that identify flare-ups of IBD using data from Danish nationwide registries.
Methods:
Using Danish nationwide administrative data, we identified all patients with Crohn's disease (CD) or ulcerative colitis (UC) who had at least one measurement of faecal calprotectin between 1 January 2015 and 31 June 2017. We tested several different claims-based indicators of disease flare-ups against levels of faecal (F-)calprotectin (no flare-up: <250 mg/kg; mild flare-up: 250-1000 mg/kg; severe flare-up: ⩾1000 mg/kg). A generalised estimating equation was used to evaluate whether the proposed indicators could predict disease activity.
Results:
A total of 890 children and 4719 adults with CD, and 592 children and 5467 adults with UC were included in the study. During the observation period, 48-61% and 48-55% of the CD and UC patients, respectively, had no flare-up, 26-29% (CD) and 24-26% (UC) experienced a mild flare-up, and 12-23% (CD) and 21-27% (UC) experienced a severe flare-up. Combinations of indicators that could predict a flare-up in CD and UC adults included hospitalisation, surgery, initiation or switch of biological therapy, treatment with systemic steroids, locally acting steroids or topical 5-aminosalicylates, colonoscopy/sigmoidoscopy, and magnetic resonance imaging/computed tomography. In children, only the number of gastroenterology visits was significant as an indicator among UC patients, and none were seen in children with CD. Overall, the indicator combinations resulted in a predictive ability of 0.62-0.67.
Conclusion:
Administrative claims data can be useful for identifying patients exhibiting (F-calprotectin defined) flare-ups of their IBD. Clinically relevant events captured in the Danish national patient registry are associated with increased levels of calprotectin and hence increased disease activity, and can be used as valid outcomes in future studies.
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