We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Is there an added value of faecal calprotectin and haemoglobin in the diagnostic work-up for primary care patients suspected of significant colorectal disease? A cross-sectional diagnostic study.
- Authors
Elias, Sjoerd G.; Kok, Liselotte; de Wit, Niek J.; Witteman, Ben J. M.; Goedhard, Jelle G.; Romberg-Camps, Mariëlle J. L.; Muris, Jean W. M.; Moons, Karel G. M.
- Abstract
Background: The majority of primary care patients referred for bowel endoscopy do not have significant colorectal disease (SCD), and are - in hindsight - unnecessarily exposed to a small but realistic risk of severe endoscopyassociated complications. We developed a diagnostic strategy to better exclude SCD in these patients and evaluated the value of adding a faecal calprotectin point-of-care (POC) and/or a POC faecal immunochemical test for haemoglobin (FIT) to routine clinical information. Methods: We used data from a prospective diagnostic study in SCD-suspected patients from 266 Dutch primary care practices referred for endoscopy to develop a diagnostic model for SCD with routine clinical information, which we extended with faecal calprotectin POC (quantitatively in µg/g faeces) and/or POC FIT results (qualitatively with a 6 µg/g faeces detection limit). We defined SCD as colorectal cancer (CRC), inflammatory bowel disease, diverticulitis, or advanced adenoma (>1 cm). Results: Of 810 patients, 141 (17.4%) had SCD. A diagnostic model with routine clinical data discriminated between patients with and without SCD with an area under the receiver operating characteristic curve (AUC) of 0. 741 (95% CI, 0.694-0.789). This AUC increased to 0.763 (95% CI, 0.718-0.809; P = 0.078) when adding the calprotectin POC test, to 0.831 (95% CI, 0.791-0.872; P < 0.001) when adding the POC FIT, and to 0.837 (95% CI, 0. 798-0.876; P < 0.001) upon combined extension. At a = 5.0% SCD probability threshold for endoscopy referral, 30. 4% of the patients tested negative based on this combined POC-tests extended model (95% CI, 25.7-35.3%), with 96.4% negative predictive value (95% CI, 93.1-98.2%) and 93.7% sensitivity (95% CI, 88.2-96.8%). Excluding the calprotectin POC test from this model still yielded 30.1% test negatives (95% CI, 24.7-35.6%) and 96.0% negative predictive value (95% CI, 92.6-97.9%), with 93.0% sensitivity (95% CI, 87.4-96.4%). Conclusions: FIT - and to a much lesser extent calprotectin - POC testing showed incremental value for SCD diagnosis beyond standard clinical information. A diagnostic strategy with routine clinical data and a POC FIT test may safely rule out SCD and prevent unnecessary endoscopy referral in approximately one third of SCD-suspected primary care patients.
- Subjects
DIAGNOSIS of colon diseases; PRIMARY care; ENDOSCOPY; FECAL occult blood tests; HEMOGLOBINOMETRY; POINT-of-care testing
- Publication
BMC Medicine, 2016, Vol 14, p1
- ISSN
1741-7015
- Publication type
Article
- DOI
10.1186/s12916-016-0684-5