P237. Differential diagnosis between intestinal tuberculosis and Crohn's disease - A prospective multicenter study from China
Y. He1, Z. Zhu2, Y. Chen3, W. Liao2, C. Ouyang4, M. Huang5, R. Hu6, Y. Yang7, J. Qian7, Q. Ouyang6, X. Wu4, B. Xia5, N. Lv2, M. Chen1, P. Hu1, 1The First Affiliated Hospital of SunYat-Sen University, Gastroenterology, Guangzhou, China, 2The First Affiliated Hospital of Nanchang University, Gastroenterology, Nanchang, China, 3The First Affiliated Hospital of SunYat-Sen University, Medical Ultrasonics, Guangzhou, China, 4The Second Xiangya Hospital of Central South University, Gastroenterology, Changsha, China, 5Zhongnan Hospital of Wuhan University, Gastroenterology, Wuhan, China, 6West China Hospital, Sichuan University, Gastroenterology, Sichuan, China, 7Peking Union Medical College Hospital, Gastroenterology, Beijing, China
To identify the independent predictors for the differential diagnosis between ITB and ileocolic CD, and to establish a prediction model to instruct clinical work.
ITB and ileocolic CD patients from six medical centers were recruited from Aug, 2011 to Mar, 2013. Data of clinical manifestation, laboratory examination, colonoscopy with biopsy, CTE were collected from all recruited patients. First a univariate analysis was performed to identify factors with significant differences between ITB and ileocolic CD groups. Then a multivariate analysis was performed further to identify independent factors which could differentiate ITB for ileocolic CD. Finally a prediction model was established using these independent factors by using logistic regression analysis.
- One hundred and twenty-four CD and ITB cases were enrolled in our study.
- Univariate analysis showed that 8 variants of clinical manifestation, 7 variants of laboratory examination, 12 variants of colonoscopy, and 9 variants of CTE were significant different between ITB and ileocolic CD. But no parameters of biopsy was found significant different between two groups.
- Multivariate analysis showed that 8 variants were independent factors for the differential diagnosis between ITB and ileocolic CD, including PLT, TSPOT positive, transverse ulcer, patulous ileocecal valve, involvement of sigmoid colon, involvement of small intestine, comb sign, and perianal lesion (Table 1).
- Predicted model was constructed by multivariate analysis as follows, Logit P = −2.703 + 0.012·PLT − 4.264·(TSPOT positive) − 4.253·(transverse ulcer) − 3.569·(patulous ileocecal valve) + 1.507·(involvement of sigmoid colon) + 1.869·(involvement of small intestine) + 1.885·(comb sign) + 1.797·(perianal lesion). The best diagnostic cut-off point (P = 0.4979) are obtained by ROC analysis (Figure 1). The sensitivity and specificity of the model to identify ITB patients were 88.57% and 100% respectively, and the AUC was 0.9798.
|Regression coefficient||Standard error||P value||OR (95% CI)|
|TSPOT positive||−4.264||1.207||0.000||0.014 (0.001–0.150)|
|Transverse ulcer||−4.253||1.502||0.005||0.014 (0.001–0.270)|
|Patulous ileocecal valve||−3.569||3.127||0.254||0.028 (0.000–12.939)|
|Involvement of sigmoid colon||1.507||1.249||0.228||4.512 (0.390–52.185)|
|Involvement of small intestine||1.869||1.247||0.134||6.480 (0.563–74.636)|
|Comb sign||1.885||1.080||0.081||6.584 (0.793–54.688)|
|Perianal lesion||1.797||1.715||0.295||6.029 (0.209–173.720)|
- PLT, TSPOT positive, transverse ulcer, patulous ileocecal valve, involvement of sigmoid colon, involvement of small intestine, comb sign, and perianal lesion are important features for distinguishing between ITB and ileocolic CD.
- Predicted model was constructed with high sensitivity and specificity for the differential diagnosis between ITB and ileocolic CD.