A272 PERFORMANCE OF TISSUE TRANSGLUTAMINASE ANTIBODIES FOR A DIAGNOSIS OF CELIAC DISEASE IS DECREASED IN ADULTS WITH OTHER COMORBIDITIES
Notice bibliographique
Résumé
Tissue transglutaminase antibodies(tTG) is a first step for detection of celiac disease(CeD). However, in a pediatric population, an increase of <3 times UNL was poorly predictive of CeD. In adults, discrepancies between tTG and histology were reported with liver disorders and how these and other comorbidities influence the performance of tTG remains unknown. To determine the positive predictive value(PPV) of the degree of increase of tTG for newly diagnosed biopsy-proven CeD(BxCeD) in adults with and without other comorbidities. Retrospective study based on chart review from August 2003 to June 2016. Inclusion criteria: all patients with a dosage of tTG at the Centre Hospitalier de l’Université de Montréal and duodenal biopsies done three months before to six months after tTG. Exclusion criteria: inadequate histologic specimen, CeD already known or being on a gluten free diet. Patients were identified as BxCeD if histology corresponded to Marsh type 1 up to 3c. Medical records were reviewed for comordibities at the time of the dosage of tTG, namely liver disorders, auto-immune, infectious diseases and inflammatory states. Patients with and without these comorbidities were classified as Dis+ or Dis- groups. ROC curve analysis was performed to determine the UNL threshold where sensitivity(Sn) and specificity(Sp) are optimized for diagnosis of BxCeD in both groups. PPVs below and above these thresholds were calculated and compared with Fisher’s exact tests. 206 patients were included; 63% of women; mean age(±SD) 48(±16)years. BxCeD was identified in 80% of patients(n=164). Overall, 73 patients were found with ≥1 relevant comorbidities(Dis+ group), mainly liver diseases(n=32), connective tissue diseases(n=11), and inflammatory bowel diseases(n=7). BxCeD was found in 60% of them while this proportion was of 90% in the Dis- group. ROC curve in the Dis- group revealed that Sp/Sn were optimized at 2.74 times UNL. When PPV were calculated according to this threshold (Table), PPVs were significantly lower in the Dis+ group vs. the Dis- group. In the Dis+ group, the threshold optimizing the Sp/Sn of the tTg test was 3.83 times UNL, which increased the PPV to 88% among these patients. The performance of the tTG test for detecting biopsy-proven CeD is decreased significantly by the presence of comorbidities such as liver disorders, other auto-immune diseases, infections, and inflammatory states. PPV of the tTG for BxCeD according to the presence of other comorbidities Dis +: either liver, auto-immune, infectious or inflammatory disease at the time of tTG None
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».