Diverticular Inflammation and Complication Assessment classification, CODA score and fecal calprotectin in clinical assessment of patients with diverticular disease: A decision curve analysis.
CODA score
DICA score
acute diverticulitis
diverticular disease
diverticulosis
fecal calprotectin
Journal
United European gastroenterology journal
ISSN: 2050-6414
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
12
11
2022
accepted:
29
01
2023
medline:
12
9
2023
pubmed:
8
8
2023
entrez:
8
8
2023
Statut:
ppublish
Résumé
The Diverticular Inflammation and Complication Assessment (DICA) classification and the Combined Overview on Diverticular Assessment (CODA) were found to be effective in predicting the outcomes of Diverticular Disease (DD). We ascertain whether fecal calprotectin (FC) can further aid in improving risk stratification. A three-year international, multicentre, prospective cohort study was conducted involving 43 Gastroenterology and Endoscopy centres. Survival methods for censored observations were used to estimate the risk of acute diverticulitis (AD) in newly diagnosed DD patients according to basal FC, DICA, and CODA. The net benefit of management strategies based on DICA, CODA and FC in addition to CODA was assessed with decision curve analysis, which incorporates the harms and benefits of using a prognostic model for clinical decisions. At the first diagnosis of diverticulosis/DD, 871 participants underwent FC measurement. FC was associated with the risk of AD at 3 years (HR per each base 10 logarithm increase: 3.29; 95% confidence interval, 2.13-5.10) and showed moderate discrimination (c-statistic: 0.685; 0.614-0.756). DICA and CODA were more accurate predictors of AD than FC. However, FC showed high discrimination capacity to predict AD at 3 months, which was not maintained at longer follow-up times. The decision curve analysis comparing the combination of FC and CODA with CODA alone did not clearly indicate a larger net benefit of one strategy over the other. FC measurement could be used as a complementary tool to assess the immediate risk of AD. In all other cases, treatment strategies based on the CODA score alone should be recommended.
Sections du résumé
BACKGROUND AND AIMS
The Diverticular Inflammation and Complication Assessment (DICA) classification and the Combined Overview on Diverticular Assessment (CODA) were found to be effective in predicting the outcomes of Diverticular Disease (DD). We ascertain whether fecal calprotectin (FC) can further aid in improving risk stratification.
METHODS
A three-year international, multicentre, prospective cohort study was conducted involving 43 Gastroenterology and Endoscopy centres. Survival methods for censored observations were used to estimate the risk of acute diverticulitis (AD) in newly diagnosed DD patients according to basal FC, DICA, and CODA. The net benefit of management strategies based on DICA, CODA and FC in addition to CODA was assessed with decision curve analysis, which incorporates the harms and benefits of using a prognostic model for clinical decisions.
RESULTS
At the first diagnosis of diverticulosis/DD, 871 participants underwent FC measurement. FC was associated with the risk of AD at 3 years (HR per each base 10 logarithm increase: 3.29; 95% confidence interval, 2.13-5.10) and showed moderate discrimination (c-statistic: 0.685; 0.614-0.756). DICA and CODA were more accurate predictors of AD than FC. However, FC showed high discrimination capacity to predict AD at 3 months, which was not maintained at longer follow-up times. The decision curve analysis comparing the combination of FC and CODA with CODA alone did not clearly indicate a larger net benefit of one strategy over the other.
CONCLUSIONS
FC measurement could be used as a complementary tool to assess the immediate risk of AD. In all other cases, treatment strategies based on the CODA score alone should be recommended.
Identifiants
pubmed: 37550901
doi: 10.1002/ueg2.12369
pmc: PMC10493361
doi:
Substances chimiques
Leukocyte L1 Antigen Complex
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
642-653Investigateurs
Marco Astegiano
(M)
Francesco Bachetti
(F)
Gianluca Baldassarre
(G)
Fabio Baldi
(F)
Edoardo Borsotti
(E)
Claudio Cassieri
(C)
Alessia Cazzato
(A)
Stefania Chiri
(S)
Antonio Ciccone
(A)
Alberto Damiani
(A)
Patrizia De Colibus
(P)
Roberto Faggiani
(R)
Fabio Finocchiaro
(F)
Serafina Fiorella
(S)
Francesca Foschia
(F)
Federica Furfaro
(F)
Sara Gallina
(S)
Gian Marco Giorgetti
(GM)
Simona Grad
(S)
Giuseppe Grande
(G)
Antonio Grandolfo
(A)
Maria Antonia Lai
(MA)
Piera Giuseppina Lecca
(PG)
Daniele Lisi
(D)
Loris Riccardo Lopetuso
(LR)
Antonio Penna
(A)
Flavia Pigò
(F)
Piero Portincasa
(P)
Giannenrico Rizzatti
(G)
Giovanni Luca Rizzo
(GL)
Stefania Scanni
(S)
Luigi Schiffino
(L)
Ieva Stundiene
(I)
Antonino Tesoriere
(A)
Riccardo Urgesi
(R)
Paolo Usai
(P)
Informations de copyright
© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.
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