title: Correlation of anemia status with worsening bowel damage as measured by Lémann Index in patients with Crohn's disease.
abstract: BACKGROUND
  There is evidence that anemia in Crohn's disease (CD) is a predictor of disease severity.
  
  
  OBJECTIVE
  To evaluate if patterns of anemia over time showed correlation with aggressive disease trajectory, as characterized by change in Lémann Index (LI), which is a metric that quantifies bowel damage.
  
  
  METHODS
  CD patients with 5 year (y) follow-up from a prospective registry were included. LI was calculated from the first (LI1) and last (LI2) clinical encounters. The change in score (LI2-LI1) or the Delta LI (DLI) was recorded. Patterns of anemia, healthcare utilization and disease activity scores were analyzed.
  
  
  RESULTS
  A total of 389 CD patients with 5y follow-up formed the study population [median age 40y (IQR: 31-53); 57.3% female; median disease duration 12y (IQR: 6-20.5), overall surgical exposure 69%]. Patients with anemia had significantly higher LI1, LI2, DLI and also significantly higher healthcare utilization and indices of disease activity, than patients without anemia (p<0.001). CD patients with anemia for any duration during the study had OR of 2.15 (95% CI 1.29-3.57, p=0.003) for worsening bowel damage over the 5y.
  
  
  CONCLUSIONS
  Based on a longitudinal analysis of CD patients, anemia status over time shows significant correlation with increasing Lémann index and aggressive disease trajectory.
authors.affiliation: Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Bhavana
authors.initials: B
authors.lastname: Bhagya Rao
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Koutroubakis
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Claudia Ramos
authors.initials: CR
authors.lastname: Rivers
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Regueiro
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Swoger
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Schwartz
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Baidoo
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Jana
authors.initials: J
authors.lastname: Hashash
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Barrie
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dunn
authors.affiliation: Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA. Electronic address: binion@pitt.edu.
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007420:Intestine, Large / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Anemia; Crohn's disease; Lémann Index