| Diagnostic Accuracy of Point-of-Care Fecal Calprotectin and Immunochemical Occult Blood Tests for Diagnosis of Organic Bowel Disease in Primary Care: The Cost-Effectiveness of a Decision Rule for Abdominal Complaints in Primary Care (CEDAR) Study. | |
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MedLine Citation:
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PMID: 22407858 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND:Fecal biomarker tests that differentiate between organic bowel disease (OBD) and non-OBD in primary care patients with persistent lower-abdomen complaints could reduce the number of unnecessary referrals for endoscopy. We quantified the accuracy of fecal calprotectin and immunochemical occult blood (iFOBT) point-of-care (POC) tests and a calprotectin ELISA in primary care patients with suspected OBD.METHODS:We performed biomarker tests on fecal samples from 386 patients with lower-abdomen complaints suggestive for OBD. Endoscopic and histological diagnosis served as reference.RESULTS:OBD was diagnosed in 99 patients (prevalence 25.9%); 19 had adenocarcinoma, 53 adenoma, and 27 inflammatory bowel disease. Sensitivity for OBD was 0.64 (95% CI 0.54-0.72) for calprotectin POC, 0.56 (0.46-0.66) for iFOBT POC, and 0.74 (0.65-0.82) for calprotectin ELISA; specificities were 0.53 (0.48-0.59), 0.83 (0.78-0.87), and 0.47 (0.41-0.53), respectively. Negative predictive values (NPVs) were 0.81 (0.74-0.86), 0.85 (0.80-0.88), and 0.84 (0.78-0.89); positive predictive values (PPVs) varied from 0.32 (0.26-0.39) and 0.33 (0.27-0.39) (calprotectin tests) to 0.53 (0.44-0.63) (iFOBT POC). Combining the 2 POC tests improved sensitivity [0.79 (0.69-0.86)] and NPV [0.87 (0.81-0.91)] but lowered specificity [0.49 (0.44-0.55)] and PPV [0.35 (0.29-0.42)]. When adenomas ≤1 cm were considered non-OBD, the NPV of all tests improved to >0.90 [combined POC tests, 0.97 (0.93-0.99)].CONCLUSIONS:Diagnostic accuracy of the tests alone or combined was insufficient when all adenomas were considered OBD. When only adenomas >1 cm were considered OBD, all tests could rule out OBD to a reasonable extent, particularly the combined POC tests. The tests were less useful for inclusion of OBD. |
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Authors:
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Liselotte Kok; Sjoerd G Elias; Ben J M Witteman; Jelle G Goedhard; Jean W M Muris; Karel G M Moons; Niek J de Wit |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-3-9 |
Journal Detail:
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Title: Clinical chemistry Volume: - ISSN: 1530-8561 ISO Abbreviation: - Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-3-12 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9421549 Medline TA: Clin Chem Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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