Serum antibodies to microbial antigens for Crohn's disease progression: a meta-analysis.

ABSTRACT

OBJECTIVES: This meta-analysis evaluated the stratification powers of four well-studied serum antibodies to microbial antigens [ASCA (anti-Saccharomyces cerevisiae), anti-OmpC (anti-outer-membrane protein C), anti-I2 (anti-Pseudomonas fluorescens-associated sequence I2), and anti-CBir1 (anti-bacterial flagellin)] in characterizing progression of Crohn's disease (CD). METHODS: Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence intervals (CI) for individual antibodies and antibody combination were used to evaluate and compare their stratification powers for CD-related complications and the need for surgery. RESULTS: Eleven studies were included in this meta-analysis. In terms of the outcomes for CD complication and surgery, ASCA had the highest sensitivities at 0.66 (CI 0.63-0.69) for complications and 0.66 (CI 0.63-0.68) for surgery, whereas anti-OmpC had the highest specificities at 0.83 (CI 0.80-0.85) for complications and 0.81 (CI 0.79-0.83) for surgery. Anti-OmpC had the highest DORs at 2.61 (CI 2.16-3.15) for complications and 2.93 (CI 2.48-3.47) for surgery, and a combination of at least two antibodies presented pooled DORs at 2.93 (CI 2.42-3.56) for complications and 3.39 (CI 2.73-4.20) for surgery, superior to any single antibody. CONCLUSION: Anti-OmpC had the highest stratification power among the four antibodies screened for the risk of both complications and surgery in CD patients, and the power became stronger when antibodies were assessed in combination.