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Lémann Index at Diagnosis Predicts the Risk of Early Surgery in Crohn’s Disease

Liu, Wei, M.D.1,2; Zhou, Wei, M.D., Ph.D.1,2; Xiang, Jianjian, M.D.1; Cao, Qian, M.D., Ph.D.2,3; Zhu, Jinzhou, M.D., Ph.D.4; Qi, Weilin, M.D.1; Chen, Pengpeng, M.D.1; Xie, Qingwen, M.D.1

doi: 10.1097/DCR.0000000000000930
Original Contributions: Inflammatory Bowel Disease
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BACKGROUND: Identifying patients with Crohn’s disease with rapid disease progress or high risk of early surgery is crucial to clinical decision making.

OBJECTIVE: The aim was to evaluate the correlation between the Lémann index at diagnosis and abdominal surgery in the first year after Crohn’s disease diagnosis and to find the risk factors for early surgery.

DESIGN: This was a retrospective cohort study.

SETTINGS: The study was conducted at a single tertiary hospital.

PATIENTS: Patients diagnosed with Crohn’s disease between 2013 and 2015 in our center were included.

MAIN OUTCOME MEASURES: The outcome of interest was the need for an abdominal surgery within 1 year after the Lémann index evaluation at diagnosis.

RESULTS: Of 212 eligible patients, 48 patients underwent abdominal surgery during follow-up. Lémann index was much higher in the surgery group (5.3 vs 2.6; p < 0.001). On tertiles of the Lémann index, the frequency of surgery grew (2.8%, 9.9%, and 55.7%; p < 0.001) as the Lémann index increased. The receiver operating characteristic curve was constructed taking into account the Lémann index for selecting patients with a high risk of surgery. Specificity, sensitivity, and area under receiver operating characteristic curve were 84.8%, 81.3%, and 0.89 of the Lémann Index at a cutoff level of 3.7. Patients with Lémann index ≥3.7 carried a higher risk of abdominal surgery (OR = 18.6; p < 0.001). Stricturing and penetrating disease were predictors for abdominal surgery, whereas antitumor necrosis factor treatment was associated with a significant reduction of surgical requirements.

LIMITATIONS: This study was limited by its retrospective design. The ability of the Lémann index to predict the long-term risk of surgery was unknown.

CONCLUSIONS: Lémann index at diagnosis is a reliable index to predict the risk of abdominal surgery in the first year after diagnosis of Crohn’s disease. Patients with a high Lémann index might need closer follow-up or aggressive medical therapy. See Video Abstract at http://links.lww.com/DCR/A518.

1 Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China

2 Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China

3 Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China

4 School of Medicine, Zhejiang University, Hangzhou, China

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: This work was supported by the Natural Science Foundation of Zhejiang Province (LY15H160031).

Financial Disclosure: None reported.

Correspondence: Wei Zhou, Department of General Surgery, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou 310016, China. E-mail: nuzwlvran@aliyun.com

© 2018 The American Society of Colon and Rectal Surgeons