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Validation and Update of the Lémann Index to Measure Cumulative Structural Bowel Damage in Crohn's Disease
B. Pariente, J. Torres, J. Burisch, N. Arebi, B. Barberio, D. Duricova, P. Ellul, A. Goldis, I. Kaimakliotis, K. Katsanos, Ž. Krznaric, D. McNamara, N. Pedersen, S. Sebastian, M. Azahaf, P. Weimers, P. Lung, C. Lacognata, M. Horak, D....
Language English Country United States
Document type Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't, Validation Study
Grant support
K23 DK111995
NIDDK NIH HHS - United States
- MeSH
- Crohn Disease diagnostic imaging pathology surgery MeSH
- Adult MeSH
- Endoscopy, Gastrointestinal * MeSH
- Colonoscopy MeSH
- Humans MeSH
- Magnetic Resonance Imaging * MeSH
- Decision Support Techniques * MeSH
- Tomography, X-Ray Computed MeSH
- Predictive Value of Tests MeSH
- Prospective Studies MeSH
- Cross-Sectional Studies MeSH
- Reproducibility of Results MeSH
- Intestines diagnostic imaging pathology surgery MeSH
- Severity of Illness Index MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Validation Study MeSH
- Geographicals
- New York City MeSH
- Europe MeSH
BACKGROUND & AIMS: The Lémann Index is a tool measuring cumulative structural bowel damage in Crohn's disease (CD). We reported on its validation and updating. METHODS: This was an international, multicenter, prospective, cross-sectional observational study. At each center, 10 inclusions, stratified by CD duration and location, were planned. For each patient, the digestive tract was divided into 4 organs, upper tract, small bowel, colon/rectum, anus, and subsequently into segments, explored systematically by magnetic resonance imaging and by endoscopies in relation to disease location. For each segment, investigators retrieved information on previous surgical procedures, identified predefined strictures and penetrating lesions of maximal severity (grades 1-3) at each organ investigational method (gastroenterologist and radiologist for magnetic resonance imaging), provided segmental damage evaluation ranging from 0.0 to 10.0 (complete resection). Organ resection-free cumulative damage evaluation was then calculated from the sum of segmental damages. Then investigators provided a 0-10 global damage evaluation from the 4-organ standardized cumulative damage evaluations. Simple linear regressions of investigator damage evaluations on their corresponding Lémann Index were studied, as well as calibration plots. Finally, updated Lémann Index was derived through multiple linear mixed models applied to combined development and validation samples. RESULTS: In 15 centers, 134 patients were included. Correlation coefficients between investigator damage evaluations and Lémann Indexes were >0.80. When analyzing data in 272 patients from both samples and 27 centers, the unbiased correlation estimates were 0.89, 0,97, 0,94, 0.81, and 0.91 for the 4 organs and globally, and stable when applied to one sample or the other. CONCLUSIONS: The updated Lémann Index is a well-established index to assess cumulative bowel damage in CD that can be used in epidemiological studies and disease modification trials.
American Gastroenterology Center Cyprus
Department of Gastroenterology Medical Division Hvidovre University Hospital Hvidovre Denmark
Department of Gastroenterology North Zealand University Hospital Capital Region Denmark
Department of Gastroenterology Slagelse Hospital Slagelse Denmark
Department of Gastroenterology University of Medicine Timișoara România
Department of Radiology Na Homolce Hospital Prague Czech Republic
Department of Radiology Tallaght University Hospital Dublin Ireland
Division of Gastroenterology Surgical Department Hospital Beatriz Ângelo Loures Portugal
Hepato Gastroenterology Department Claude Huriez Hospital University of Lille Lille France
Inflammatory Bowel Diseases Clinical and Research Center ISCARE a s Prague Czech Republic
Institute of Pharmacology 1st Faculty of Medicine Charles University Prague Czech Republic
Mater Dei Hospital Department of Medicine Division of Gastroenterology Msida Malta
Radiology Department Claude Huriez hospital University of Lille Lille France
Radiology Department St Mark's Hospital and Imperial College London United Kingdom
Radiology Unit University of Padova Padova Italy
TAGG Research Centre School of Medicine Trinity College Dublin Dublin Ireland
References provided by Crossref.org
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