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Development and Validation of a Novel Prediction Model for Differential Diagnosis Between Crohn's Disease and Intestinal Tuberculosis.
- Source :
-
Inflammatory bowel diseases [Inflamm Bowel Dis] 2017 Sep; Vol. 23 (9), pp. 1614-1623. - Publication Year :
- 2017
-
Abstract
- Background: Although colonoscopy is useful for differentiating between Crohn's disease (CD) and intestinal tuberculosis (ITB), the technique has limitations. We developed a practical prediction model for differentiating between CD and ITB using laboratory and radiologic parameters and colonoscopic characteristics.<br />Methods: We prospectively enrolled 80 patients newly diagnosed with CD (n = 40) and ITB (n = 40). We developed a new prediction score by integrating colonoscopic, laboratory, and radiologic parameters. The score's predictive ability was validated on an additional 37 patients.<br />Results: The accuracy of colonoscopic scoring for differentiation was 81.2% (65/80), with 65.0% sensitivity for CD and 97.5% for ITB. In multivariate analysis, positive IgA and/or IgG anti-Saccharomyces cerevisiae antibody and involvement of the proximal intestine were the independent laboratory and radiologic parameters for CD, and positive QuantiFERON-TB Gold In-Tube Test and typical pulmonary TB findings were the parameters for ITB. A new prediction scoring combining colonoscopic, laboratory, and radiologic factors increased the accuracy of diagnosis from 81.2% to 96.3% (77/80). The CD prediction score (from -2 to 2) estimated the likelihood of CD, from 0.3% for patients scoring -2 to 100% for patients scoring 2. The area under the receiver operating characteristic curve of the score was 0.990 in the development group and 0.981 in the validation group.<br />Conclusions: The new prediction model using a CD prediction score can be useful for calculating the probability of either CD or ITB at initial evaluation (NCT01392365).
- Subjects :
- Adult
Antibodies, Fungal blood
Area Under Curve
Diagnosis, Differential
Female
Gastroenteritis microbiology
Humans
Likelihood Functions
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prospective Studies
Saccharomyces cerevisiae immunology
Sensitivity and Specificity
Tuberculosis, Gastrointestinal microbiology
Young Adult
Colonoscopy statistics & numerical data
Crohn Disease diagnosis
Gastroenteritis diagnosis
Radiography statistics & numerical data
Tuberculosis, Gastrointestinal diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1536-4844
- Volume :
- 23
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Inflammatory bowel diseases
- Publication Type :
- Academic Journal
- Accession number :
- 28682807
- Full Text :
- https://doi.org/10.1097/MIB.0000000000001162