Development and Validation of a Novel Diagnostic Nomogram to Differentiate between Intestinal Tuberculosis and Crohn's Disease: A 6-year Prospective Multicenter Study

Yao He, Zhenhua Zhu, Yujun Chen, Fang Chen, Yufang Wang, Chunhui Ouyang, Hong Yang, Meifang Huang, Xiaodong Zhuang, Ren Mao, Shomron Ben-Horin, Xiaoping Wu, Qin Ouyang, Jiaming Qian, Nonghua Lu, Pinjing Hu*, Minhu Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES:Differentiating Crohn's disease (CD) from intestinal tuberculosis (ITB) remains a diagnostic challenge. Misdiagnosis carries potential grave implications. We aimed to develop and validate a novel diagnostic nomogram for differentiating them.METHODS:In total, 310 eligible patients were recruited from 6 tertiary inflammatory bowel disease centers. Among them, 212 consecutive patients (143 CD and 69 ITB) were used in the derivation cohort for the establishment of diagnostic equation and nomogram; 7 investigative modalities including clinical manifestations, laboratory results, endoscopic findings, computed tomography enterography features, and histology results were used to derive the diagnostic model and nomogram. Ninety-eight consecutive patients (76 CD and 22 ITB) were included for validation of the diagnostic model.RESULTS:Eight out of total 79 parameters were identified as valuable parameters used for establishing diagnostic equations. Two regression models were built based on 7 differential variables: age, transverse ulcer, rectum involvement, skipped involvement of the small bowel, target sign, comb sign, and interferon-gamma release assays (for model 1) or purified protein derivative (for model 2), respectively. Accordingly, 2 nomograms of the above 2 models were developed for clinical practical use, respectively. Further validation test verified the efficacy of the nomogram 1 with 90.9% specificity, 86.8% sensitivity, 97.1% PPV, 66.7% negative predictive value (NPV), and 87.8% accuracy for identifying CD, and the efficacy of the nomogram 2 with 100% specificity, 84.2% sensitivity, 100% positive predictive value, 64.7% NPV, and 87.8% accuracy for diagnosing CD.CONCLUSIONS:The derivation and validation cohorts identified and validated 2 highly accurate and practical diagnostic nomograms for differentiating CD from ITB. These diagnostic nomograms can be conveniently used to identify some difficult CD or ITB cases, allowing for decision-making in a clinical setting.

Original languageEnglish
Pages (from-to)490-499
Number of pages10
JournalAmerican Journal of Gastroenterology
Volume114
Issue number3
DOIs
StatePublished - 1 Mar 2019

Funding

FundersFunder number
Health Research and Special Projects Grant of China201002020
National Natural Science Foundation of China81670607
Guangzhou Science, Technology and Innovation Commission201707010091

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