Correlated Expression of High-Sensitivity C-Reactive Protein in Relation to Disease Activity in Inflammatory Bowel Disease: Lack of Differences between Crohn’s Disease and Ulcerative Colitis

Abstract

Background/Aims: As opposed to regular C-reactive protein (CRP) assays, the introduction of high-sensitivity ones has enabled us to detect low grade inflammation in patients with inflammatory bowel disease (IBD). We addressed the subject of the degree of correlation between the concentration of high-sensitivity CRP (hs-CRP) and the inflammatory IBD activity score. Methods: Included were 90 patients with Crohn’s disease (CD), 70 with ulcerative colitis (UC) and 160 controls. Disease activity was determined using CD activity index (CDAI) for CD and Mayo score for UC. The Dade Boering BNII Nephelometer was used to determine the hs-CRP concentrations. Results: The coefficient of correlation between hs-CRP and the disease activity score was similar for both UC (0.26) and CD (0.36). Conclusions: These findings are relevant for therapeutic intervention in which a greater absolute reduction in the hs-CRP concentration in CD patients (who generally present higher CRP concentrations than those found in UC) might be interpreted as a better response compared to the same absolute reduction in UC patients. This information is needed for clinicians using the hs-CRP assay to estimate IBD disease activity in daily practice.

Serum lipopolysaccharide-binding protein and soluble CD14 are markers of disease activity in patients with Crohnʼs disease

“…First, CRP is widely used in CD, since it shows acceptable correlation with disease activity delineated/defined by clinical indices 23 and also endoscopic or histological activity 26,37 and in the present study endoscopic/histological activity was not assessed. Instead, we used a more vigorous, composite endpoint-as suggested also by the recent position paper by the International Organization for Inflammatory Bowel Diseases 38 -to identify clinically relevant relapses (CDAI >150, DCDAI >100, and change in medical therapy) beyond the use of CDAI only, which is known to correlate poorly with the result of endoscopic or histological activity.…”

“…In the present study our aim was to investigate the association between serum LBP and sCD14 and clinical disease activity, the high-sensitivity C-reactive protein (hs-CRP), 23 and clinical phenotype in a large cohort of Hungarian CD patients. We also assessed the predictive value of these markers for disease flare-up.…”

Increased Folate Intake with No Changes in Serum Homocysteine and Decreased Levels of C-Reactive Protein in Patients with Inflammatory Bowel Diseases

“…Despite having some advantages compared with other indices, CRP is far from an ideal parameter for these conditions [30]. Some studies have evaluated the association between CRP and clinical scores in IBD, showing a good association of CRP with disease activity, more frequently in Crohn's disease [30,31] and less frequently in cases of ulcerative colitis [14,32].…”

Clinical significance of inflammatory markers

“…New high-sensitivity CRP assays also demonstrate good correlation with disease activity indices (DAI) for UC and CD [21]. In UC patients, increasing levels of CRP over time correlated with increasing extent of disease.…”