TY - JOUR
T1 - Development and Validation of a Novel Diagnostic Nomogram to Differentiate between Intestinal Tuberculosis and Crohn's Disease
T2 - A 6-year Prospective Multicenter Study
AU - He, Yao
AU - Zhu, Zhenhua
AU - Chen, Yujun
AU - Chen, Fang
AU - Wang, Yufang
AU - Ouyang, Chunhui
AU - Yang, Hong
AU - Huang, Meifang
AU - Zhuang, Xiaodong
AU - Mao, Ren
AU - Ben-Horin, Shomron
AU - Wu, Xiaoping
AU - Ouyang, Qin
AU - Qian, Jiaming
AU - Lu, Nonghua
AU - Hu, Pinjing
AU - Chen, Minhu
N1 - Publisher Copyright:
© 2018 by The American College of Gastroenterology.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85062644817&partnerID=8YFLogxK
U2 - 10.14309/ajg.0000000000000064
DO - 10.14309/ajg.0000000000000064
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C2 - 30741735
AN - SCOPUS:85062644817
SN - 0002-9270
VL - 114
SP - 490
EP - 499
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 3
ER -
