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.
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.
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.
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.
1Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China;
2Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China;
3Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China;
4Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, People's Republic of China;
5Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China;
6Department of Gastroenterology, Zhongnan Hospital, Wuhan University School of Medicine, Wuhan, Hubei Province, People's Republic of China;
7Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China;
8Department of Gastroenterology, IBD Service, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
Correspondence: Minhu Chen, MD, PhD. E-mail: firstname.lastname@example.org. Pinjing Hu, MD. E-mail: email@example.com
SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A22.
Received May 08, 2018
Accepted November 08, 2018