TY - JOUR
T1 - Validation and update of the Lémann index to measure cumulative structural bowel damage in Crohn's disease
AU - Pariente, Benjamin
AU - Torres, Joana
AU - Burisch, Johan
AU - Arebi, Naila
AU - Barberio, Brigida
AU - Duricova, Dana
AU - Ellul, Pierre
AU - Goldis, Adrian
AU - Kaimakliotis, Ioannis
AU - Katsanos, Konstantinos
AU - Krznaric, Željko
AU - Namara, Deirdre Mc
AU - Pedersen, Natalia
AU - Sebastian, Shaji
AU - Azahaf, Mustapha
AU - Weimers, Petra
AU - Lung, Philip
AU - Lacognata, Carmelo
AU - Horak, Martin
AU - Christodoulou, Dimitrios
AU - Domislovic, Viktor
AU - Murphy, Ian
AU - Lambert, Jérôme
AU - Ungaro, Ryan
AU - Colombel, Jean-Frédéric
AU - Mary, Jean-Yves
N1 - Copyright © 2021. Published by Elsevier Inc.
PY - 2021/9
Y1 - 2021/9
N2 - 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.
AB - 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.
KW - Crohn's Disease
KW - Bowel Damage
KW - Lemann Index
KW - Validation
U2 - 10.1053/j.gastro.2021.05.049
DO - 10.1053/j.gastro.2021.05.049
M3 - Article
C2 - 34052277
SN - 0016-5085
VL - 161
SP - 853-864.e13
JO - Gastroenterology
JF - Gastroenterology
IS - 3
ER -