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Prospective Validation of the Lémann Index in Children: A Report From the Multicentre Image Kids Study
Gili Focht1,2, Ruth Cytter Kuint3,2, Mary-Louise C Greer4,5
1Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
The updated Lémann Index (LI) for Crohn's disease shows poor performance in children, lacking sufficient validity and responsiveness for clinical use. A pediatric-specific index may be necessary for accurate assessment in this age group.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Biomarkers
Background:
- The Lémann Index (LI) assesses structural bowel damage in adult Crohn's disease (CD).
- No validation of the updated LI exists for pediatric CD populations.
- The ImageKids study aimed to validate the updated LI in children with CD.
Purpose of the Study:
- To validate the updated Lémann Index (LI) in a prospective, multicenter cohort of pediatric Crohn's disease (CD) patients.
- To assess the psychometric properties of the updated LI, including reliability, validity, and responsiveness.
Main Methods:
- Included 240 children with CD undergoing MRE, MRI, and ileocolonoscopy.
- Assessed inter-observer reliability, construct validity, responsiveness, and test-retest reliability.
- Calculated LI from MRE, ileocolonoscopy, physical exam, and surgical data; collected serum for proteomic markers.
Main Results:
- Excellent inter-observer reliability (ICC=0.94) for the updated LI.
- Poor correlation with clinical assessments and fibrotic markers (rho=0.15-0.30).
- Low discriminative validity (AUC-ROC=0.69) and suboptimal responsiveness (AUC-ROC=0.58).
Conclusions:
- The updated Lémann Index demonstrates insufficient psychometric performance for pediatric use.
- Current LI lacks adequate validity and responsiveness in children with Crohn's disease.
- Development of a pediatric-specific index is recommended for accurate assessment.
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.
