Predicting inflammatory bowel disease in children with abdominal pain and diarrhoea : calgranulin-C versus calprotectin stool tests

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 6-17years, 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 mu g/g, calprotectin: 50 mu g/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 (Cl) 94% to 99%) vs 71% (95% Cl 63% to 79%), respectively). When ROC-based thresholds were used (calgranulin-C: 0.75 mu g/g, calprotectin: 400 mu g/g), both tests performed equally well (specificity: 97% (95% Cl 94% to 99%) vs 98% (95% Cl 95% to 100%)). Conclusions: Both calgranulin-C and calprotectin have excellent test characteristics to predict IBD and justify endoscopy.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 6-17years, 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 mu g/g, calprotectin: 50 mu g/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 (Cl) 94% to 99%) vs 71% (95% Cl 63% to 79%), respectively). When ROC-based thresholds were used (calgranulin-C: 0.75 mu g/g, calprotectin: 400 mu g/g), both tests performed equally well (specificity: 97% (95% Cl 94% to 99%) vs 98% (95% Cl 95% to 100%)). Conclusions: Both calgranulin-C and calprotectin have excellent test characteristics to predict IBD and justify endoscopy.A