Delineation of Crohn's Disease Trajectories Using Change in Lémann Index

Bhavana Bhagya Rao, Ioannis E. Koutroubakis, Claudia Ramos Rivers, Jean Frederic Colombel, Miguel Regueiro, Jason Swoger, Marc Schwartz, Leonard Baidoo, Jana Hashash, Arthur Barrie, Michael A. Dunn, David G. Binion*

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background: Crohn's disease (CD) causes lifelong, progressive bowel damage, which may be quantified using the Lémann Index (LI). We aimed to analyze patterns of LI and its association with 5-year clinical course, in an independent cohort of CD patients. Methods: CD patients with 5-year follow-up from a registry maintained at a tertiary center were included. LI was calculated using a computerized metric from the first (LI1) and last (LI2) clinical encounters during the 5 years. Groups were created based on change in score (LI2-LI1) or the delta Lémann Index (DLI) as showing improvement, no change, or deterioration and used for association analysis with patterns of health care utilization, disease activity, and quality-of-life scores. Results: A total of 363 CD patients with 5-year follow-up formed the study population [median age 43 y (interquartile range (IQR), 33.3 to 55 y); 57% female; median disease duration 12 y (IQR, 3 to 19 y), overall surgical exposure 69.7%]. Median (IQR) LI1, LI2, and DLI were 8 (0 to 54), 9 (0 to 75), and 0 (-22 to-47), respectively. Patients were stratified based on DLI into 3 groups: A: DLI<0; B: DLI=0; and C: DLI>0; which comprised 16.5%, 35.3%, and 48.2% of the cohort, respectively. Patients in group C had significantly higher CD-related surgical exposure, health care utilization, and annual use of steroids and biological agents. DLI showed independent significant positive correlation with perianal disease (P=0.044), steroid use (P=0.007), clinical visits (P<0.001), and new surgeries (P=0.001). Conclusions: Change in LI over time could function as a marker of disease trajectory for risk substratification and prognostication in CD.

Original languageEnglish (US)
Pages (from-to)476-482
Number of pages7
JournalJournal of Clinical Gastroenterology
Volume50
Issue number6
DOIs
StatePublished - Jan 1 2016

Keywords

  • C-reactive protein
  • Crohn's disease
  • Lémann index
  • digestive tract damage
  • quality of life

ASJC Scopus subject areas

  • Gastroenterology

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    Bhagya Rao, B., Koutroubakis, I. E., Ramos Rivers, C., Colombel, J. F., Regueiro, M., Swoger, J., Schwartz, M., Baidoo, L., Hashash, J., Barrie, A., Dunn, M. A., & Binion, D. G. (2016). Delineation of Crohn's Disease Trajectories Using Change in Lémann Index. Journal of Clinical Gastroenterology, 50(6), 476-482. https://doi.org/10.1097/MCG.0000000000000463