Development of the Lémann Index to Assess Digestive Tract Damage in Patients With Crohn's Disease

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 148; no. 1; pp. 52 - 63.e3
• Main Authors: Pariente, Benjamin, Mary, Jean-Yves, Danese, Silvio, Chowers, Yehuda, De Cruz, Peter, D’Haens, Geert, Loftus, Edward V., Louis, Edouard, Panés, Julian, Schölmerich, Jürgen, Schreiber, Stefan, Vecchi, Maurizio, Branche, Julien, Bruining, David, Fiorino, Gionata, Herzog, Matthias, Kamm, Michael A., Klein, Amir, Lewin, Maïté, Meunier, Paul, Ordas, Ingrid, Strauch, Ulrike, Tontini, Gian-Eugenio, Zagdanski, Anne-Marie, Bonifacio, Cristiana, Rimola, Jordi, Nachury, Maria, Leroy, Christophe, Sandborn, William, Colombel, Jean-Frédéric, Cosnes, Jacques
• Format: Journal Article Web Resource
• Language: English
• Published: United States Elsevier Inc 01.01.2015; Elsevier; Saunders
• Subjects: Adult; Australia; Chemical Sciences; Colonoscopy; Crohn Disease - diagnosis; Crohn Disease - diagnostic imaging; Crohn Disease - pathology; Cross-Sectional Studies; Diagnostic Imaging - methods; Europe; Female; Gastroenterology & hepatology; Gastroenterology and Hepatology; Gastroentérologie & hépatologie; Gastrointestinal Tract - diagnostic imaging; Gastrointestinal Tract - pathology; Human health sciences; Humans; Illness Index Severity; Israel; Linear Models; Magnetic Resonance Imaging; Male; Middle Aged; MRI; Multimodal Imaging; Observer Variation; Organic chemistry; Predictive Value of Tests; Prognosis; Prospective Studies; Radiologie, médecine & imagerie nucléaire; Radiology, nuclear medicine & imaging; Reproducibility of Results; Response to Therapy; Sciences de la santé humaine; Severity of Illness Index; Tomography, X-Ray Computed; CD; CT; Prognosis; DVD; MRI; CDAI; CI; Illness Index Severity; ICC; Response to Therapy; IPNIC; IQR; computed tomography; magnetic resonance imaging; interquartile range; International Program to develop New Indexes in Crohn’s disease; Crohn’s Disease Activity Index; digital versatile disc; intraclass correlation coefficient; confidence interval; Crohn’s disease
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2014.09.015

There is a need for a scoring system that provides a comprehensive assessment of structural bowel damage, including stricturing lesions, penetrating lesions, and surgical resection, for measuring disease progression. We developed the Lémann Index and assessed its ability to measure cumulative structural bowel damage in patients with Crohn’s disease (CD). We performed a prospective, multicenter, international, cross-sectional study of patients with CD evaluated at 24 centers in 15 countries. Inclusions were stratified based on CD location and duration. All patients underwent clinical examination and abdominal magnetic resonance imaging analyses. Upper endoscopy, colonoscopy, and pelvic magnetic resonance imaging analyses were performed according to suspected disease locations. The digestive tract was divided into 4 organs and subsequently into segments. For each segment, investigators collected information on previous operations, predefined strictures, and/or penetrating lesions of maximal severity (grades 1–3), and then provided damage evaluations ranging from 0.0 (no lesion) to 10.0 (complete resection). Overall level of organ damage was calculated from the average of segmental damage. Investigators provided a global damage evaluation (from 0.0 to 10.0) using calculated organ damage evaluations. Predicted organ indexes and Lémann Index were constructed using a multiple linear mixed model, showing the best fit with investigator organ and global damage evaluations, respectively. An internal cross-validation was performed using bootstrap methods. Data from 138 patients (24, 115, 92, and 59 with upper tract, small bowel, colon/rectum, and anus CD location, respectively) were analyzed. According to validation, the unbiased correlation coefficients between predicted indexes and investigator damage evaluations were 0.85, 0.98, 0.90, 0.82 for upper tract, small bowel, colon/rectum, anus, respectively, and 0.84 overall. In a cross-sectional study, we assessed the ability of the Lémann Index to measure cumulative structural bowel damage in patients with CD. Provided further successful validation and good sensitivity to change, the index should be used to evaluate progression of CD and efficacy of treatment.