Preliminary Case-control Study to Evaluate Diagnostic Values of C-Reactive Protein and Erythrocyte Sedimentation Rate in Differentiating Active Crohn’s Disease From Intestinal Lymphoma, Intestinal Tuberculosis and Behcet’s Syndrome

doi:10.1097/MAJ.0b013e3182959a18

The American Journal of the Medical Sciences

Volume 346, Issue 6, December 2013, Pages 467-472

https://doi.org/10.1097/MAJ.0b013e3182959a18 Get rights and content

Abstract

Background

There are few evidences of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) in differentiating active Crohn’s disease (CD) from intestinal lymphoma (IL), intestinal tuberculosis (ITB) and Behcet’s syndrome (BD). This study is designed to investigate potential differential capacity of the 3 biomarkers between these disorders.

Methods

A hospital-based case-control study was performed. A total of 29 active CD, 25 IL, 30 ITB and 17 BD patients were collected. Laboratory parameters were drawn from the first blood test results on admission.

Results

In active CD group, the level of CRP was 20.2 = 4.26 mg/dL, which was statistically lower than IL (59.9 = 10.8 mg/dL, P < 0.0001). Similarly, the level of ESR reached its lowest point in active CD group (23.8 = 3.18 mm/hr), compared with 46.6 = 6.46 mm/hr in IL group (P = 0.0002). CRP showed a possible diagnostic value in differentiation of IL from active CD (odds ratio = 1.028, P = 0.046). CRP also exhibited a superior ability (area under curve [AUC] = 0.821) than ESR (AUC = 0.797) and CRP+ESR (AUC = 0.800) in distinguishing active CD from IL. The optimal cutoff value was 19.7 mg/dL, and the sensitivity and specificity were 62.1% and 96.0%, respectively.

Conclusions

A significant decreased level of CRP and ESR was confirmed in active CD compared with IL. Current study demonstrated a possible differential value of CRP between active CD and IL. Further studies would be performed to validate their clinical significances.

Section snippets

Ethical Consideration

This study was approved by the Ethics Committee of Jinling Hospital, Medical School of Nanjing University.

Study Population

This is a hospital-based case-control study. The study population included patients newly diagnosed as active CD and registered in the electronical Jinling Hospital inflammatory bowel disease (IBD) database between January 2008 and December 2011. Controls, including IL, ITB and BD, were individuals newly diagnosed in the same period and age, gender, body mass index and geographically

Demographic Information

Twenty-nine active CD, 25 IL, 30 ITB and 17 BD patients were collected in this study. Age, gender, body mass index (Table 1) and geographic distribution (data not shown) were similar among these groups. All enrolled patients were homogenous Chinese.

According to the Montreal classification of Crohn’s disease,¹⁰ L1 (ileal) was the most common disease location (41.4%) and B2 (stricturing) was the most common disease behavior (48.3%) in CD group. The CDAI score was 238.6 = 12.5 with maximum and

DISCUSSION

In clinical care of patients with IBD, biomarkers are currently used in conjunction with invasive testing, such as endoscopy and radiology, to support making diagnosis,11., 12. differentiating between CD and ulcerative colitis (UC),13., 14. monitoring disease activity12., 15. and predicting responses to therapy.16., 17. During the last decade, a series of serological and fecal biomarkers has brought significant concerns in the field of IBD.

For many reasons, blood-based biomarkers seem to be

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This work was supported by from the National Nature Science Foundation of China Grant 81270478/H0312 and the Climb Program in Natural Science Foundation of Jiangsu Province for Distinguished Scholars Grant BK2010017.

The authors have no financial or other conflicts of interest to disclose.

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Clinical InvestigationPreliminary Case-control Study to Evaluate Diagnostic Values of C-Reactive Protein and Erythrocyte Sedimentation Rate in Differentiating Active Crohn’s Disease From Intestinal Lymphoma, Intestinal Tuberculosis and Behcet’s Syndrome

Abstract

Background

Methods

Results

Conclusions

Section snippets

Ethical Consideration

Study Population

Demographic Information

DISCUSSION

Lancet

Inflamm Bowel Dis

Transl Res

J Autoimmun

Clin Gastroenterol Hepatol

Gastroenterology

Am J Gastroenterol

Clin Chim Acta

Long-term complications, extraintestinal manifestations, and mortality in adult Crohn’s disease in population-based cohorts

Inflamm Bowel Dis

Differential diagnosis between Crohn’s disease and intestinal tuberculosis in China

Int J Clin Pract

The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease

Gastroenterology

World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010

Inflamm Bowel Dis

Criteria for diagnosis of Behcet’s disease. International Study Group for Behcet’s Disease

Lancet

The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications

Gut

Review of fecal biomarkers in inflammatory bowel disease

Dis Colon Rectum

Clinical Investigation
Preliminary Case-control Study to Evaluate Diagnostic Values of C-Reactive Protein and Erythrocyte Sedimentation Rate in Differentiating Active Crohn’s Disease From Intestinal Lymphoma, Intestinal Tuberculosis and Behcet’s Syndrome