Validation of disease severity index for predicting complicated disease in Crohn's disease: A comparison study with Lémann index

Abstract

BackgroundDisease Severity Index (DSI) provides comprehensive assessment of bowel damage (BD). AimsTo evaluate DSI in patients with Crohn's disease (CD) at high risk of disease progression, compared to Lémann Index (LI). MethodsPatients with CD in our center were reviewed consecutively between 2017 and 2019. DSI, LI, and complicated CD course were analyzed. ResultsThe median LI and DSI of included 300 patients were 1.63 (IQR 1.25–3.13) and 42 (IQR 32–51), respectively. 152 patients (50.7%) experienced a complicated disease course (median 5.1 months; IQR 1.1–20.2). DSI (AUC 0.66; 95% CI 0.60–0.72) better predicted a complicated course of CD over LI (AUC 0.56; 95% CI 0.50–0.63; P = 0.007). The cumulative probability of complicated CD course in severe patients was higher than those with ‘mild CD’ (P < 0.001). The Cox analysis identified DSI>43 (HR 2.18; 95% CI 1.54–3.09; P < 0.001), B2/3 vs. B1 (HR 2.80; 95% CI 1.99–3.94; P < 0.001), and a higher level of CRP (HR 1.01; 95% CI 1.00–1.02; P = 0.005) as independent prognostic factors for complicated CD. However, LI was not associated with complicated CD (P = 0.164). ConclusionsHigher DSI was associated with complicated disease outcomes. DSI might play a better role than LI in identifying patients at high risks of disease progression.