Dataset Information

Prospective Validation of the Lemann Index in Children: A Report From the Multicentre Image Kids Study.

ABSTRACT:

Background

The Lémann Index [LI] and the recently updated LI are tools for measuring structural bowel damage in adults with Crohn's disease [CD] but have not been evaluated in children. We aimed to validate the updated LI in the prospective multicentre ImageKids study of paediatric CD.

Methods

We included children with CD undergoing magnetic resonance enterography [MRE], pelvic magnetic resonance imaging [MRI] and ileocolonoscopy. Half were followed for 18 months, when MRE was repeated. Serum was collected for fibrosis-related proteomic markers. The LI was calculated by central readers from the MRE, ileocolonoscopy, physical examination and surgical data. Reliability and construct validity were assessed at baseline, while responsiveness and test-retest reliability were explored longitudinally.

Results

In total, 240 children were included (mean age, 14.2 ± 2.5 years; median disease duration, 2.2 years [interquartile range, IQR 0.25-4.42]; median baseline LI, 4.23 [IQR 2.0-8.8]). The updated LI had excellent inter-observer reliability (interclass correlation coefficient [ICC] = 0.94, 95% confidence interval [CI] 0.92-0.95) but poor, although statistically significant, correlation with radiologist and gastroenterologist global assessments of damage and with serum proteomic levels of fibrotic markers [rho = 0.15-0.30, most p < 0.05]. The updated LI had low discriminative validity for detecting damage (area under the receiver operating characteristic curve [AUC-ROC] 0.69, 95% CI 0.62-0.75). In 116 repeated MREs, responsiveness was suboptimal for differentiating improved from unchanged disease [AUC-ROC 0.58, 95% CI 0.45-0.71]. Test-retest reliability was high among stable patients [ICC = 0.84, 95% CI 0.72-0.91].

Conclusion

Overall, the updated LI had insufficient psychometric performance for recommending its use in children. An age-specific index may be needed for children with shorter disease duration than typical adult cohorts.

SUBMITTER: Focht G

PROVIDER: S-EPMC11004934 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Prospective Validation of the Lémann Index in Children: A Report From the Multicentre Image Kids Study.

Focht Gili G Kuint Ruth Cytter RC Greer Mary-Louise C MC Pratt Li-Tal LT Castro Denise A DA Church Peter C PC Navas-López Víctor Manuel VM Baldassano Robert N RN Mortensen Joachim Høg JH Rieder Florian F Yerushalmi Baruch B Ilivitzki Anat A Konen Osnat O Griffiths Anne M AM Turner Dan D

Journal of Crohn's & colitis 20230601 6

<h4>Background</h4>The Lémann Index [LI] and the recently updated LI are tools for measuring structural bowel damage in adults with Crohn's disease [CD] but have not been evaluated in children. We aimed to validate the updated LI in the prospective multicentre ImageKids study of paediatric CD.<h4>Methods</h4>We included children with CD undergoing magnetic resonance enterography [MRE], pelvic magnetic resonance imaging [MRI] and ileocolonoscopy. Half were followed for 18 months, when MRE was rep ...[more]

PMID: 36756849

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