P0344 Comparative analysis of a simple POPSIL score with Lémann Index to define the burden of organ damage in Crohn’s disease
Authors: Ong S , Grant R , Cartlidge P , Campbell I , Hall R , MacDonald J , Seenan J P , Mowat C , Chuah C S , Kalla R , Ho G T 
Published: January 2025

Background

Uncontrolled inflammation in Crohn’s disease (CD) can lead to progressive bowel damage such as strictures, fistulae and abscesses. There is currently no practical measure for organ damage that is available for clinicians to use. Presently, the Lémann Index(LI) incorporates analysis of multiple bowel segments and complication coefficient multiplication (with minimum 60 data points) that is difficult to apply in real-world clinical setting(1). We designed a simple score derived from LI to capture risk factors of Penetrating, Organ Involvement, Perianal, Stricturing, Inflammation and Length (POPSIL) that can track the evolution of organ damage in CD and that can be universally applied to routine clinical data (Table 1).

Methods

We applied the LI and POPSIL score to CD patients from the MUSIC and GI-DAMPs IBD study(www.musicstudy.uk); a prospective 12-month longitudinal study and cross-sectional study following active IBD patients in response to current drug treatment respectively. All participants undergo endoscopic evaluation at baseline and again at 3-6 months for mucosal assessment; and MRI small bowel where clinically indicated. We calculated Pearson correlation coefficients to compare the LI results with the POPSIL score. In addition, we analysed organ damage scores with patient-reported outcomes of wellbeing (CUCQ32) in particular, pain, fatigue and psycho-social welfare.

Results

In total, of 312 CD patients with complete data, 72 (23.1%) patients had small bowel MRI and colonoscopy data within 60 days (median time between two tests was 26.5 days; IQR 5.75-44.25 days) of recruitment to enable both LI/POPSIL scores to be calculated. In this cohort, median age was 31 years (IQR 26-42), 36 female (50%). A total of 20.8% (n=15) patients were current smokers. The median BMI was 25 (IQR 21.4-29.4). Overall, median LI was 19.5 (IQR 8.3-26.4). Median POPSIL score was 6 (IQR 5-8) where in our cohort POPSIL scores were classified according to severity (Table 1): Mild 3.2% (n=2), Moderate 41.2% (n=26), Severe 49.2% (n=31) and Very Severe 6.4% (n=4). POPSIL score is significantly correlated with LI (r=0.6, p&lt;0.001). CUCQ32 were not correlated with neither LI and POPSIL scores. The time taken to calculate the scores for LI and POPSIL per patient were 3 minutes and 1 minute respectively.

Conclusion

The POPSIL score has comparable effectiveness to the LI in assessing global bowel damage. Its ease of calculation suggests that it may be a more practical method to assess burden of organ damage over time, response to drug therapy and prognostic determination of disease course. To develop the POPSIL score, we will incorporate patient-reported outcomes and larger scale validation of this approach.

References

1)Pariente B, Torres J, Burisch J, et al. Validation and Update of the Lémann Index to Measure Cumulative Structural Bowel Damage in Crohn’s Disease. Gastroenterology. 2021 Sep;161(3):853-864.e13