66 research outputs found
Faecal calprotectin in suspected paediatric inflammatory bowel disease.
Objectives: The diagnostic accuracy of faecal calprotectin (FC) concentration for paediatric inflammatory bowel disease (IBD) is well described at
the population level, but not at the individual level. We reassessed the
diagnostic accuracy of FC in children with suspected IBD and developed an
individual risk prediction rule using individual patient data.
Methods: MEDLINE, EMBASE, DARE, and MEDION databases were
searched to identify cohort studies evaluating the diagnostic performance
of FC in paediatric patients suspected of having IBD. A standard study-level
meta-analysis was performed. In an individual patient data meta-analysis, we
reanalysed the diagnostic accuracy on a merged patient dataset. Using logistic
regression analysis we investigated whether and how the FC value and patient
characteristics influence the diagnostic precision. A prediction rule was derived for use in clinical practice and implemented in a spreadsheet calculator.
Results: According to the study-level meta-analysis (9 studies, describing
853 patients), FC has a high overall sensitivity of 0.97 (95% confidence
interval [CI] 0.92–0.99) and a specificity of 0.70 (0.59–0.79) for diagnosing
IBD. In the patient-level pooled analysis of 742 patients from 8 diagnostic
accuracy studies, we calculated that at an FC cutoff level of 50 mg/g there
would be 17% (95% CI 15–20) false-positive and 2% (1–3) false-negative
results. The final logistic regression model was based on individual data of
545 patients and included both FC level and age. The area under the receiver
operating characteristic curve of this derived prediction model was 0.92
(95% CI 0.89–0.94).
Conclusions: In high-prevalence circumstances, FC can be used as a
noninvasive biomarker of paediatric IBD with only a small risk of
missing cases. To quantify the individual patients’ risk, we developed a
simple prediction model based on FC concentration and age. Although the
derived prediction rule cannot substitute the clinical diagnostic process, it
can help in selecting patients for endoscopic evaluation
- …