Open AccessValidation of models using basic parameters to differentiate intestinal tuberculosis from Crohn’s disease: A multicenter study from Asia
Author(s) -
Julajak Limsrivilai,
Choon Kin Lee,
Piyapan Prueksapanich,
Kamin Harinwan,
Asawin Sudcharoen,
Natcha Cheewasereechon,
Satimai Aniwan,
Pimsiri Sripongpan,
Panu Wetwittayakhlang,
Ananya Pongpaibul,
Anapat Sanpavat,
thalee Pausawasdi,
Phunchai Charatcharoenwitthaya,
Peter Higgins,
Siew C. Ng
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0242879
Subject(s) - medicine , crohn's disease , endoscopy , receiver operating characteristic , gastroenterology , cutoff , disease , physics , quantum mechanics
Background Data on external validation of models developed to distinguish Crohn’s disease (CD) from intestinal tuberculosis (ITB) are limited. This study aimed to validate and compare models using clinical, endoscopic, and/or pathology findings to differentiate CD from ITB. Methods Data from newly diagnosed ITB and CD patients were retrospectively collected from 5 centers located in Thailand or Hong Kong. The data was applied to Lee, et al ., Makharia, et al ., Jung, et al ., and Limsrivilai, et al . model. Results Five hundred and thirty patients (383 CD, 147 ITB) with clinical and endoscopic data were included. The area under the receiver operating characteristic curve (AUROC) of Limsrivilai’s clinical-endoscopy (CE) model was 0.853, which was comparable to the value of 0.862 in Jung’s model (p = 0.52). Both models performed significantly better than Lee’s endoscopy model (AUROC: 0.713, p<0.01). Pathology was available for review in 199 patients (116 CD, 83 ITB). When 3 modalities were combined, Limsrivilai’s clinical-endoscopy-pathology (CEP) model performed significantly better (AUROC: 0.887) than Limsrivilai’s CE model (AUROC: 0.824, p = 0.01), Jung’s model (AUROC: 0.798, p = 0.005) and Makharia’s model (AUROC: 0.637, p <0.01). In 83 ITB patients, the rate of misdiagnosis with CD when used the proposed cutoff values in each original study was 9.6% for Limsrivilai’s CEP, 15.7% for Jung’s, and 66.3% for Makharia’s model. Conclusions Scoring systems with more parameters and diagnostic modalities performed better; however, application to clinical practice is still limited owing to high rate of misdiagnosis of ITB as CD. Models integrating more modalities such as imaging and serological tests are needed.