title: Delineation of Crohn's Disease Trajectories Using Change in Lémann Index: A Natural History Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  Change in LI over time could function as a marker of disease trajectory for risk substratification and prognostication in CD.
authors.affiliation: *Department of Internal Medicine, Division of General Internal Medicine †Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA ‡Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Icahn School of Medicine at Mount Sinai, New York City, NY.
authors.forename: Bhavana
authors.initials: B
authors.lastname: Bhagya Rao
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Koutroubakis
authors.forename: Claudia
authors.initials: C
authors.lastname: Ramos Rivers
authors.forename: Jean Frederic
authors.initials: JF
authors.lastname: Colombel
authors.forename: Miguel
authors.initials: M
authors.lastname: Regueiro
authors.forename: Jason
authors.initials: J
authors.lastname: Swoger
authors.forename: Marc
authors.initials: M
authors.lastname: Schwartz
authors.forename: Leonard
authors.initials: L
authors.lastname: Baidoo
authors.forename: Jana
authors.initials: J
authors.lastname: Hashash
authors.forename: Arthur
authors.initials: A
authors.lastname: Barrie
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dunn
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D015331:Cohort Studies; D003424:Crohn Disease / Q000188:drug therapy / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
chemical_list: D000305:Adrenal Cortex Hormones; D007155:Immunologic Factors