Endoscopic diagnosis of acute intestinal GVHD following allogeneic hematopoietic SCT: a retrospective analysis in 175 patients
Autor: | K Potthoff, P Deibert, J Harder, Hartmut Bertz, Wolfgang Kreisel, M Dahlberg, Jürgen Finke, Annette Schmitt-Graeff |
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Rok vydání: | 2011 |
Předmět: |
medicine.medical_specialty
Time Factors Transplantation Conditioning Erythema medicine.medical_treatment Graft vs Host Disease Colonoscopy Hematopoietic stem cell transplantation Sensitivity and Specificity Gastroenterology Predictive Value of Tests Internal medicine medicine Humans Transplantation Homologous Retrospective Studies Transplantation intestinal aGVHD integumentary system medicine.diagnostic_test business.industry allogeneic hematologic SCT Hematopoietic Stem Cell Transplantation Reproducibility of Results Endoscopy Immunosuppression Retrospective cohort study Hematology Surgery Gastrointestinal Tract Diarrhea Treatment Outcome Predictive value of tests Original Article medicine.symptom business |
Zdroj: | Bone Marrow Transplantation |
ISSN: | 1476-5365 0268-3369 |
Popis: | Diagnosis of acute intestinal GVHD (aGVHD) following allogeneic hematopoietic cell transplantation is based on clinical symptoms and histological lesions. This retrospective analysis aimed to validate the ‘Freiburg Criteria' for the endoscopic grading of intestinal aGVHD. Grade 1: no clear-cut criteria; grade 2: spotted erythema; grade 3: aphthous lesions; and grade 4: confluent defects, ulcers, denudation of the mucosa. Having excluded patients with infectious diarrhea, we evaluated 175 consecutive patients between January 2001 and June 2009. Setting a cutoff between grade 1 (no change in therapy) and grade 2 (intensification of immunosuppression), macroscopy had a sensitivity of 89.2% (95% confidence interval (CI): 80.4–94.9%), a specificity of 79.4% (95% CI: 69.6–87.1%), a positive-predictive value of 79.6% (95% CI: 70.0–87.2%) and a negative-predictive value of 89.0% (95% CI: 80.2–94.9%). In all, 20% of patients with aGVHD in the lower gastrointestinal tract (GIT) had lesions only in the terminal ileum. In all patients with aGVHD ⩾2 of the upper GIT, typical lesions were also found in the lower GIT. Ileo-colonoscopy showed the highest diagnostic yield for aGVHD. In conclusion, the ‘Freiburg Criteria' for macroscopic diagnosis of intestinal aGVHD provide high accuracy for identifying aGVHD ⩾2. |
Databáze: | OpenAIRE |
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