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Faecal calprotectin to detect inflammatory bowel disease : a systematic review and exploratory meta-analysis of test accuracy
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Freeman, Karoline, Willis, Brian H., Fraser, Hannah, Taylor-Phillips, Sian and Clarke, Aileen (2019) Faecal calprotectin to detect inflammatory bowel disease : a systematic review and exploratory meta-analysis of test accuracy. BMJ Open, 9 (3). e027428. doi:10.1136/bmjopen-2018-027428
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WRAP-faecal-calprotectin-detect-inflammatory-bowel-disease-meta-Freeman-2019.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1967Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/bmjopen-2018-027428
Abstract
Objective
Test accuracy of faecal calprotectin (FC) testing in primary care is inconclusive. We aimed to assess the test accuracy of FC testing in primary care and compare it to secondary care estimates for the detection of inflammatory bowel disease (IBD).
Methods
Systematic review and meta-analysis of test accuracy using a bivariate random effects model. We searched MEDLINE, EMBASE, Cochrane Library and Web of Science until 31 May 2017 and included studies from auto alerts up until 31 January 2018. Eligible studies measured FC levels in stool samples to detect IBD in adult patients with chronic (at least 6–8 weeks) abdominal symptoms in primary or secondary care. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. We followed the protocol registered as PROSPERO CRD 42012003287.
Results
38 out of 2168 studies were eligible including five from primary care. Comparison of test accuracy by setting was precluded by extensive heterogeneity. Overall, summary estimates of sensitivity and specificity were not recorded. At a threshold of 50 µg/g, sensitivity from separate meta-analysis of four assay types ranged from 0.85 (95% CI 0.75 to 0.92) to 0.94 (95% CI 0.75 to 0.90) and specificity from 0.67 (95% CI 0.56 to 0.76) to 0.88 (95% CI 0.77 to 0.94). Across three different definitions of disease, sensitivity ranged from 0.80 (95% CI 0.76 to 0.84) to 0.97 (95% CI 0.91 to 0.99) and specificity from 0.67 (95% CI 0.58 to 0.75) to 0.76 (95% CI 0.66 to 0.84). Sensitivity appears to be lower in primary care and is further reduced at a revised threshold of 100 µg/g.
Conclusions
Conclusive estimates of sensitivity and specificity of FC testing in primary care for the detection of IBD are still missing. There is insufficient evidence in the published literature to support the decision to introduce FC testing in primary care. Studies evaluating FC testing in an appropriate primary care setting are needed.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School | ||||||
| Library of Congress Subject Headings (LCSH): | Inflammatory bowel diseases, Feces | ||||||
| Journal or Publication Title: | BMJ Open | ||||||
| Publisher: | BMJ | ||||||
| ISSN: | 2044-6055 | ||||||
| Official Date: | 8 March 2019 | ||||||
| Dates: |
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| Date of first compliant deposit: | 12 March 2019 | ||||||
| Volume: | 9 | ||||||
| Number: | 3 | ||||||
| Article Number: | e027428 | ||||||
| DOI: | 10.1136/bmjopen-2018-027428 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| RIOXX Funder/Project Grant: |
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