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Predicting inflammatory bowel disease in children with abdominal pain and diarrhoea: calgranulin-C versus
Anke Heida1, Els Van de Vijver2, Don van Ravenzwaaij3
1Department of Paediatric Gastroenterology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Calgranulin-C and calprotectin are effective fecal markers for predicting inflammatory bowel disease (IBD) in children. Both tests demonstrate excellent characteristics, supporting their use in guiding endoscopy decisions.
Area of Science:
- Gastroenterology
- Pediatrics
- Clinical Diagnostics
Background:
- Inflammatory bowel disease (IBD) diagnosis in children with chronic abdominal pain and diarrhea often relies on invasive procedures.
- Fecal inflammatory markers like calprotectin are used, but specificity can be an issue.
- Calgranulin-C (S100A12) is a novel fecal marker proposed to be more specific for IBD.
Purpose of the Study:
- To compare the diagnostic accuracy of calgranulin-C and calprotectin in predicting IBD in children.
- To determine which fecal marker, calgranulin-C or calprotectin, better predicts IBD in pediatric patients.
Main Methods:
- A cross-sectional diagnostic study involving 337 children aged 6-17 years with undiagnosed chronic abdominal pain and diarrhea.
- Patients underwent endoscopy or were followed for 6 months based on IBD likelihood.
- Bayesian modeling was used to correct for verification bias, comparing predefined and ROC-based thresholds for calgranulin-C and calprotectin.
Main Results:
- Calgranulin-C demonstrated significantly higher specificity than calprotectin at predefined thresholds (97% vs 71%).
- At ROC-based thresholds, both markers showed comparable high specificity (97% for calgranulin-C vs 98% for calprotectin).
- IBD was diagnosed in 93 out of 337 patients.
Conclusions:
- Both calgranulin-C and calprotectin exhibit excellent test characteristics for predicting IBD in children.
- These fecal markers can help justify the need for endoscopy in pediatric patients presenting with relevant symptoms.
Objective:
Calgranulin-C (S100A12) is a new faecal marker of inflammation that is potentially more specific for inflammatory bowel disease (IBD) than calprotectin, since it is only released by activated granulocytes. We compared calgranulin-C and calprotectin to see which of the two tests best predicted IBD in children with chronic abdominal pain and diarrhoea.
Design:
Delayed-type cross-sectional diagnostic study.
Setting And Patients:
Previously undiagnosed patients aged 6-17 years, who were seen in paediatric clinics in the Netherlands and Belgium, sent in a stool sample for analysis. Patients with a high likelihood of IBD underwent upper and lower endoscopy (ie, preferred reference test), while those with a low likelihood were followed for 6 months for latent IBD to become visible (ie, alternative reference test). We used Bayesian modelling to correct for differential verification bias.
Main Outcome Measures:
Primary outcome was the specificity for IBD using predefined test thresholds (calgranulin-C: 0.75 µg/g, calprotectin: 50 µg/g). Secondary outcome was the test accuracy with thresholds based on receiver operating characteristics (ROC) analysis.
Results:
IBD was diagnosed in 93 of 337 patients. Calgranulin-C had significantly better specificity than calprotectin when predefined thresholds were used (97% (95% credible interval (CI) 94% to 99%) vs 71% (95% CI 63% to 79%), respectively). When ROC-based thresholds were used (calgranulin-C: 0.75 µg/g, calprotectin: 400 µg/g), both tests performed equally well (specificity: 97% (95% CI 94% to 99%) vs 98% (95% CI 95% to 100%)).
Conclusions:
Both calgranulin-C and calprotectin have excellent test characteristics to predict IBD and justify endoscopy.
Trial Registration Number:
NCT02197780.
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