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Title: Validation of models using basic parameters to differentiate intestinal tuberculosis from Crohn’s disease: A multicenter study from Asia
Authors: Julajak Limsrivilai
Choon Kin Lee
Piyapan Prueksapanich
Kamin Harinwan
Asawin Sudcharoen
Natcha Cheewasereechon
Satimai Aniwan
Pimsiri Sripongpan
Panu Wetwittayakhlang
Ananya Pongpaibul
Anapat Sanpavat
Nonthalee Pausawasdi
Phunchai Charatcharoenwitthaya
Peter D.R. Higgins
Siew Chien Ng
Chulalongkorn University
University of Michigan, Ann Arbor
Faculty of Medicine, Siriraj Hospital, Mahidol University
Phramongkutklao College of Medicine
Prince of Songkla University
Chinese University of Hong Kong
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology
Issue Date: 1-Nov-2020
Citation: PLoS ONE. Vol.15, No.11 November (2020)
Abstract: © 2020 Limsrivilai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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.
ISSN: 19326203
Appears in Collections:Scopus 2020

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