Development and validation of a new algorithm model for differential diagnosis between Crohn's disease and intestinal tuberculosis: a combination of laboratory, imaging and endoscopic characteristics

Abstract Background Sometimes in clinical practice, it is a great challenge to distinguish Crohn's disease (CD) and intestinal tuberculosis (ITB), we conducted this study to identify simple and useful algorithm for distinguishing them. Methods We retrospectively reviewed the medical history of the patients who were diagnosed as ITB or CD. We firstly identified ITB patients, and then the patients diagnosed with CD were matched by age, sex, and admission time in a 1:1 ratio. Patients who admitted between May 1, 2013 and April 30, 2019 were regarded as training cohort, and patients admitted between May 1, 2019 and May 1, 2020 were regarded as validation cohort. We used multivariate analysis to identify the potential variables, and then we used R package rpart to build the classification and regression tree (CART), and validated the newly developed model. Results In total, the training cohort included 84 ITB and 84 CD patients, the validation cohort included 22 ITB and 22 CD patients. Multivariate analysis showed that, positive interferon-gamma release assays (IGRAs), ≥ 4 segments involved, longitudinal ulcer, circular ulcer, and aphthous ulcer were confirmed as independent discriminating factors. Using these parameters to build the CART model made an overall accuracy rate was 88.64%, with sensitivity, specificity, NPV, and PPV being 90.91%, 86.36%, 90.48% and 86.96%, respectively. Conclusion We developed a simple and novel algorithm model covering laboratory, imaging, and endoscopy parameters with CART to differentiate ITB and CD with good accuracy. Positive IGRAs and circular ulcer were suggestive of ITB, while ≥ 4 segments involved, longitudinal ulcer, and aphthous ulcer were suggestive of CD.

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Development and Validation of a New Algorithm Model for Differential Diagnosis Between Crohn's Disease and Intestinal Tuberculosis: A Combination of Laboratory, Imaging and Endoscopic Characteristics

10.21203/rs.3.rs-176405/v1 ◽

2021 ◽

Author(s):

Yi Lu ◽

Yonghe Chen ◽

Xiang Peng ◽

Jiayin Yao ◽

Weijie Zhong ◽

...

Keyword(s):

Multivariate Analysis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Validation Cohort ◽

Intestinal Tuberculosis ◽

Regression Tree ◽

R Package ◽

Classification And Regression Tree ◽

Aphthous Ulcer ◽

Training Cohort

Abstract Background: Sometimes in clinical practice, it was a great challenge to distinguish Crohn's disease (CD) and intestinal tuberculosis (ITB), we conducted this study was to identify simple and useful algorithm for distinguishing them.Methods: We retrospectively reviewed the medical history of the patients who were diagnosed as ITB or CD. We firstly identified ITB patients, and then the patients diagnosed with CD were matched by age, sex, and admission time in a 1:1 ratio. Patients who admitted between May 1, 2013 and April 30, 2019 were regarded as training cohort, and patients admitted between May 1, 2019 and May 1, 2020 were regarded as validation cohort. We used multivariate analysis to identify the potential variables, and then we used R package rpart to build the classification and regression tree (CART), and validated the newly developed model.Results: In total, the training cohort included 84 ITB and 84 CD patients, the validation cohort included 22 ITB and 22 CD patients. Multivariate analysis showed that, positive T-SPOT, ≥4 segments involved, longitudinal ulcer, circular ulcer, and aphthous ulcer were confirmed as independent discriminating factors. Using these parameters to build the CART model made an overall accuracy rate was 88.64%, with sensitivity, specificity, NPV, and PPV being 90.91%, 86.36%, 90.48% and 86.96%, respectively.Conclusion: We developed a simple and novel algorithm model covering laboratory, imaging, and endoscopy parameters with CART to differentiate ITB and CD with good accuracy.

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Role of Colonoscopy in Differentiating Intestinal Tuberculosis from Crohn’s Disease

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_13_17 ◽

2017 ◽

Vol 08 (02) ◽

pp. 072-077 ◽

Cited By ~ 1

Author(s):

P. Rajesh Prabhu ◽

Mayank Jain ◽

Piyush Bawane ◽

Joy Varghese ◽

Jayanthi Venkataraman

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Statistical Tests ◽

Intestinal Tuberculosis ◽

Aphthous Ulcer ◽

Tb Treatment ◽

Respective Treatment ◽

Skip Lesions ◽

Histological Confirmation

ABSTRACT Background: The interface between tuberculosis (TB) and Crohn’s disease (CD) is relevant as TB complicates both the diagnosis and management of CD. Aim: This study aimed to identify the distinctive characteristics of ileocaecal and colonic TB (C‑TB) and colonic CD (C‑CD) at colonoscopy and to correlate the colonoscopy findings with histology. Materials and Methods: This prospective study included consecutive patients presenting with classical symptoms of TB or CD. The colonoscopic findings were compared with histology, which was taken as gold standard. Appropriate statistical tests were applied. Results: Fifty‑eight individuals fulfilled the inclusion criteria. Nine and 16 patients with C‑TB and C‑CD, respectively, had histological confirmation of respective diagnosis. In 33 specimens, the histological diagnosis was inconclusive. The sensitivity of colonoscopy for diagnosing C‑TB was high at 88.9% (95% confidence interval [CI]: 51.8–99.7). It was 50% (95% CI: 24.7–75.4) for CD. The reverse was true for CD whose specificity was high at 71.4% (95% CI: 55.3–84.3) and low for TB at 46.9% (95% CI: 32.5–61.7). All the patients diagnosed as confirmed CD or TB responded well to respective treatment. Six of the thirty patients with failed response to anti‑TB treatment required surgery or change in treatment after 2 months. Conclusion: Colonoscopic findings of isolated ileal involvement, aphthous ulcer, cobble stoning, long‑segment strictures, skip lesions and perianal involvement favored a diagnosis of CD. Correlation of colonoscopy with histology is poor for both CD and TB. The accuracy, sensitivity and specificity of colonoscopy were better and superior for the diagnosis of CD, than in the diagnosis of TB.

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Nomogram to predict primary non-response to infliximab in patients with Crohn’s disease: a multicenter study

Gastroenterology Report ◽

10.1093/gastro/goaa069 ◽

2020 ◽

Author(s):

Xiao-Qi Ye ◽

Jing Cai ◽

Qiao Yu ◽

Xiao-Cang Cao ◽

Yan Chen ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Validation Cohort ◽

Characteristic Curve ◽

Mucosal Healing ◽

Clinical Usefulness ◽

Secondary Outcome ◽

Training Cohort ◽

Graphical Tool ◽

Therapeutic Decision Making

Abstract Background Infliximab (IFX) is effective at inducing and maintaining clinical remission and mucosal healing in patients with Crohn’s disease (CD); however, 9%–40% of patients do not respond to primary IFX treatment. This study aimed to construct and validate nomograms to predict IFX response in CD patients. Methods A total of 343 patients diagnosed with CD who had received IFX induction from four tertiary centers between September 2008 and September 2019 were enrolled in this study and randomly classified into a training cohort (n = 240) and a validation cohort (n = 103). The primary outcome was primary non-response (PNR) and the secondary outcome was mucosal healing (MH). Nomograms were constructed from the training cohort using multivariate logistic regression. Performance of nomograms was evaluated by area under the receiver-operating characteristic curve (AUC) and calibration curve. The clinical usefulness of nomograms was evaluated by decision-curve analysis. Results The nomogram for PNR was developed based on four independent predictors: age, C-reactive protein (CRP) at week 2, body mass index, and non-stricturing, non-penetrating behavior (B1). AUC was 0.77 in the training cohort and 0.76 in the validation cohort. The nomogram for MH included four independent factors: baseline Crohn’s Disease Endoscopic Index of Severity, CRP at week 2, B1, and disease duration. AUC was 0.79 and 0.72 in the training and validation cohorts, respectively. The two nomograms showed good calibration in both cohorts and were superior to single factors and an existing matrix model. The decision curve indicated the clinical usefulness of the PNR nomogram. Conclusions We established and validated nomograms for the prediction of PNR to IFX and MH in CD patients. This graphical tool is easy to use and will assist physicians in therapeutic decision-making.

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P288 CT enterography is useful in differentiating Crohn's disease from intestinal tuberculosis

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(13)60309-8 ◽

2013 ◽

Vol 7 ◽

pp. S124-S125

Author(s):

R. Mao ◽

P.-j. Hu ◽

M.-h. Chen

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Tuberculosis ◽

Ct Enterography

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P264. Meta-analytic Bayesian model for differentiating intestinal tuberculosis from Crohn’s disease utilising clinical, endoscopic, and cross-sectional imaging findings, and the interferon-gamma releasing assay

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjw019.383 ◽

2016 ◽

Vol 10 (suppl 1) ◽

pp. S225-S226

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Interferon Gamma ◽

Bayesian Model ◽

Intestinal Tuberculosis ◽

Imaging Findings ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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Is the rise in Crohn's disease in India accompanied by a fall in intestinal tuberculosis? A single-center experience

Indian Journal of Tuberculosis ◽

10.1016/j.ijtb.2020.08.010 ◽

2020 ◽

Author(s):

Pavan Dhoble ◽

Devendra Desai ◽

Philip Abraham

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Tuberculosis ◽

Single Center ◽

Single Center Experience

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Prognostic Nutritional Index as an independent prognostic factor in locoregionally advanced squamous cell head and neck cancer

ESMO Open ◽

10.1136/esmoopen-2018-000425 ◽

2018 ◽

Vol 3 (6) ◽

pp. e000425 ◽

Cited By ~ 8

Author(s):

Gema Bruixola ◽

Javier Caballero ◽

Federica Papaccio ◽

Angelica Petrillo ◽

Aina Iranzo ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Prognostic Factor ◽

Head And Neck ◽

Squamous Cell ◽

Validation Cohort ◽

Prognostic Nutritional Index ◽

Training Cohort ◽

Lymphocyte Ratio ◽

Nutritional Index

BackgroundLocally advanced head and neck squamous cell carcinoma (LAHNSCC) is a heterogeneous disease in which better predictive and prognostic factors are needed. Apart from TNM stage, both systemic inflammation and poor nutritional status have a negative impact on survival.MethodsWe retrospectively analysed two independent cohorts of a total of 145 patients with LAHNSCC treated with induction chemotherapy followed by concurrent chemoradiotherapy at two different academic institutions. Full clinical data, including the Prognostic Nutritional Index (PNI), neutrophil to lymphocyte ratio and derived neutrophil to lymphocyte ratio, were analysed in a training cohort of 50 patients. Receiver operating characteristic curve analysis was used to establish optimal cut-off. Univariate and multivariate analyses of prognostic factors for overall survival (OS) were performed. Independent predictors of OS identified in multivariate analysis were confirmed in a validation cohort of 95 patients.ResultsIn the univariate analysis, low PNI (PNI<45) (p=0.001), large primary tumour (T4) (p=0.044) and advanced lymph node disease (N2b-N3) (p=0.025) were significantly associated with poorer OS in the validation cohort. The independent prognostic factors in the multivariate analysis for OS identified in the training cohort were dRNL (p=0.030) and PNI (p=0.042). In the validation cohort, only the PNI remained as independent prognostic factor (p=0.007).ConclusionsPNI is a readily available, independent prognostic biomarker for OS in LAHNSCC. Adding PNI to tumour staging could improve individual risk stratification of patients with LAHNSCC in future clinical trials.

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