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Crohn's Disease Activity Index (CDAI)
Ideally, the first three items should be completed by the patient 7 days prior to the next visit. A sample card is available near the bottom of this page. Click on the image to pull up a printable pdf - patient diary.
Number of liquid or soft stools
each day for seven days - Total (1 week):
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Abdominal pain
(graded from 0-3 on severity) each day for seven days- add up each individual day or if the pain level was consistent, take the average level of abdominal pain and multiply by seven.
0=
none
, 1=
mild
, 2=
moderate
, 3=
severe
. Total (past week):
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
General well-being:
subjectively assessed - 0 (generally
well
), 1=
slightly under par
, 2=
poor
, 3=
very poor
, 4 =
terrible
. Add up past 7 days prior to visit.
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Presence of complications
Arthritis / Arthralgia?:
No
Yes
Iritis / uveitis?:
No
Yes
Erythema nodosum, pyoderma gangrenosum, or aphthous stomatitis?:
No
Yes
Anal fissure, fistula or abscess?:
No
Yes
Other fistula?:
No
Yes
Fever over 100 degrees (F) in past week?:
No
Yes
Taking Lomotil or opiates for diarrhea?:
No
Yes
Hematocrit of <47% in male or <42% in female patient?:
No
Yes
Presence of an abdominal mass
(0 as none, 2 as questionable, 5 as definite)
None
Questionable mass
Definite mass
Percentage % deviation from standard or ideal weight:
No change
2-3%
4-5%
6-8%
9-10%
Gained weight?:
No
Yes
Patients who have gained weight (unusual), will subtract from the total score.
Background Info
Crohn's Disease Activity Index or CDAI
Key features:
Developed by Best WR, et al. in 1976 at the Midwest Regional Health Center in Illinois to assess patient's with Crohn's disease using an index consisting of 8 factors along with weighting factors that are summed up and then used an important benchmark to determine the effectiveness of various treatments.
The CDAI is an important research tool for quantifying symptoms as well as determining the impact of drug therapy on overall symptoms. Some therapies can lead to substantial swings in the CDAI based on the dramatic impact on the core factors that make up the index.
It is important to note, that the CDAI focuses primarily on the level of symptoms and does not assess quality of life issues.
The CDAI is considered to be the gold standard for assessing disease activity in Crohn's disease
Clinical or laboratory variable
Weighting factor
Number of liquid or soft stools
each day for seven days - Total (1 week):
x 2
Abdominal pain
(graded from 0-3 on severity) each day for seven days- add up each individual day or if the pain level was consistent, take the average level of abdominal pain and multiply by seven.
0=
none
, 1=
mild
, 2=
moderate
, 3=
severe
. Total (past week)
x 5
General well-being:
subjectively assessed - 0 (generally
well
), 1=
slightly under par
, 2=
poor
, 3=
very poor
, 4 =
terrible
. Add up past 7 days prior to visit.
x 7
Presence of complications
- One point each is added for each set of complications:
Presence of joint pains (arthralgia) or arthritis
Inflammation of the iris or uveitis
Presence of erythema nodosum, pyoderma gangrenosum, or aphthous ulcers
Anal fissures, fistulae or abscesses
Other fistulae
Fever during the previous week.
x 20
Taking Lomotil or opiates for diarrhea
x 30
Presence of an abdominal mass (0 as none, 2 as questionable, 5 as definite)
x 10
Hematocrit of <47 in men and <42 in women
x 6
Percentage deviation from standard weight
x 1
Extrapolated ranges:
<150: Very well / Remission
150-220: Mildly active disease
221-300: Moderately active disease.
301-450: Moderate to severely active disease.
>450: Very Severe disease.
Most major research studies on medications in Crohn's disease define response as a fall of the CDAI of greater than 70 points.
Click on the image below for a printable card:
References
Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976 Mar;70(3):439-44. PubMed ID: 1248701
Hanauer S, Feagan B, Lichtenstein G, Mayer L, Schreiber S, Colombel J, Rachmilewitz D, Wolf D, Olson A, Bao W, Rutgeerts P (). "Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial". Lancet. 2002. 359 (9317): 1541–9. doi:10.1016/S0140-6736(02)08512-4. PMID 12047962.
Irvine E, Feagan B, Rochon J, Archambault A, Fedorak R, Groll A, Kinnear D, Saibil F, McDonald J (1994). "Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn's Relapse Prevention Trial Study Group". Gastroenterology. 106 (2): 287–96. PMID 8299896.
Jørgensen L, Fredholm L, Hyltoft Petersen P, Hey H, Munkholm P, Brandslund I (2005). "How accurate are clinical activity indices for scoring of disease activity in inflammatory bowel disease (IBD)?". Clin Chem Lab Med. 43 (4): 403–11. doi:10.1515/CCLM.2005.073. PMID 15899657.
Sands B, Anderson F, Bernstein C, Chey W, Feagan B, Fedorak R, Kamm M, Korzenik J, Lashner B, Onken J, Rachmilewitz D, Rutgeerts P, Wild G, Wolf D, Marsters P, Travers S, Blank M, van Deventer S (2004). "Infliximab maintenance therapy for fistulizing Crohn's disease". N Engl J Med. 350 (9): 876–85. doi:10.1056/NEJMoa030815. PMID 14985485.