Defining Faecal Calprotectin Thresholds as a Surrogate for Endoscopic and Histological Disease Activity in Ulcerative Colitis—a Prospective Analysis

Walsh, Alissa J.; Kormilitzin, Andrey; Hinds, Chris; Sexton, Vanashree; Brain, Oliver; Keshav, Satish; Uhlig, Holm H.; Geddes, John; Goodwin, Guy M.; Peters, Michele; Collins, Gary S.; Travis, Simon

doi:10.1093/ecco-jcc/jjy184

Cited by 59 publications

(62 citation statements)

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“…It ranged from 72 to 250 μg/g, suggesting that patients with FC values above the threshold had a higher rate of microscopic activity of disease. The study of Walsh et al showed that a cut‐off threshold >72 μg/g had a SE of 100% and a PPV of 100% to detect microscopic inflammation. The high rate of SP and NPV was reached in the study of Magro et al with a cut‐off level >100 μg/g (100% for both the values).…”

Section: Resultsmentioning

confidence: 99%

“…Finally, 12 studies met the inclusion criteria and were included in the review. [13][14][15][25][26][27][28][29][30][31][32][33] The reviewers fully agreed on the selection of eligible articles. Three retrospective cohort studies [29][30][31] and nine prospective cohort studies [13][14][15][25][26][27][28]32,33 were investigated.…”

Section: Search Results and Study Populationmentioning

confidence: 99%

“…Geboes score 35 (four studies 14,25,27 ), Nancy index 36 (two studies 28,30 ) or nonvalidated scores (five studies 13,15,29,32,33 ). One study 31 had four definitions based on three scores (Geboes score, Nancy index and Robarts histopathologic index 37 ).…”

Section: Histologic Scores and Definition Of Histologic Remissionmentioning

confidence: 99%

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Review article: faecal calprotectin and histologic remission in ulcerative colitis

D’Amico

Bonovas

Danese

et al. 2020

Aliment Pharmacol Ther

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Summary Background Histologic healing is emerging as a new therapeutic goal in both routine practice and clinical trials in ulcerative colitis (UC). However, it requires repeated endoscopies and biopsies. Faecal calprotectin is a non‐invasive marker of mucosal healing (endoscopic and histologic healing). Aim To conduct a systematic review to clarify the correlation between faecal calprotectin levels and histologic activity in UC patients. Methods We searched PubMed/MEDLINE, EMBASE and Web of Science through September 2019 to identify studies in patients with confirmed diagnosis of UC, reporting the correlation between faecal calprotectin levels and histologic analysis. Results Twelve studies enrolling 1168 patients were included in the final review. Histologic remission was defined according to nonvalidated scores in five articles and using partially validated scores in seven articles. Faecal calprotectin values were measured in 6 of 12 studies (50%) with the same kit, while the remaining six studies adopted individually different kits. A clear correlation between faecal calprotectin levels and histology was showed in all included studies. Eleven different faecal calprotectin cut‐off points were identified to distinguish histological remission from histological activity, ranging from 40.5 to 250 μg/g. Conclusions Faecal calprotectin can be used to predict histologic remission in patients with UC, but the cut‐off level varies across studies, according to the test used to measure this biomarker and according to the definition of histologic remission. Larger prospective studies using validated histologic indexes are needed to identify a globally accepted faecal calprotectin cut‐off level to discriminate between histologic remission and histologically active disease.

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Section: Resultsmentioning

confidence: 99%

Section: Search Results and Study Populationmentioning

confidence: 99%

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Review article: faecal calprotectin and histologic remission in ulcerative colitis

D’Amico

Bonovas

Danese

et al. 2020

Aliment Pharmacol Ther

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“…Calprotectin is released by granulocyte activation and elevated level of fecal calprotectin (FC) is found in the GI tract inflammation that closely related to inflammatory bowel disease (IBD) activity . Increasing evidence indicates that FC can be used as a noninvasive marker for intestinal/colonic inflammation that helps clinicians distinguish organic inflammatory bowel disease (IBD) from functional irritable bowel syndrome (IBS) . Markers of systemic inflammation, such as C‐reactive protein (CRP) and white blood cells count, have low specificity and sensitivity for IBD, while the gold standard of ileo‐colonoscopy is invasive and expensive .…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Increasing evidence indicates that FC can be used as a noninvasive marker for intestinal/colonic inflammation that helps clinicians distinguish organic inflammatory bowel disease (IBD) from functional irritable bowel syndrome (IBS). [4][5][6] Markers of systemic inflammation, such as C-reactive protein (CRP) and white blood cells count, have low specificity and sensitivity for IBD, while the gold standard of ileo-colonoscopy is invasive and expensive. 3 Thus, noninvasive method for monitoring disease activity is preferable.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a fluorescent immunochromatography test for fecal calprotectin

Zhao

Dong

et al. 2019

Clinical Laboratory Analysis

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Background Fecal calprotectin (FC) is widely used to discriminate between patients with inflammatory diseases such as inflammatory bowel disease (IBD) and functional diseases such as irritable bowel syndrome (IBS). ELISA is a time‐consuming method for the measurement of FC, whereas a fluorescent immunochromatography test can obtain results in around 30 minutes and thus enables a rapid response to clinical decision. Methods Two methods, the Proglead® calprotectin (FC Proglead) and the BÜHLMANN fCAL® ELISA (FC BÜHLMANN), were used to quantitatively examine FC in 111 stool samples. The comparison and bias estimation of both assays were assessed using CLSI EP09c protocol. Results The two methods were highly correlated (rho = .96). Deming regression was employed to calculate the regression equation, with a slope of 1.01 and an intercept of −4.98 μg/g. The estimated median bias (FC Proglead − FC BÜHLMANN) was −4.19 μg/g with the 95% limits of agreement (−55.59 to 47.21 μg/g), and the estimated median percent bias was −8.71% with the 95% limits of agreement (−50.31% to 32.90%). There was 4.50% (5/111) of values outside the 95% limits of agreement. Percent biases at the FC cutoff values of 50 and 200 μg/g between both methods evaluated by Deming regression were 8.96% and 1.49%, respectively. The biases were all less than the acceptable standard (10%). And, 99.10% of FC results were in agreement between both methods (kappa = .99, P < .001). Conclusions FC Proglead may be used as a suitable alternative to FC BÜHLMANN for the disease activity assessment for patients with IBD, considering its convenience and shorter turnaround time.

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PICaSSO virtual electronic chromendoscopy accurately reflects combined endoscopic and histological assessment for prediction of clinical outcomes in ulcerative colitis

et al. 2022

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Background and Aims A composite endoscopic‐histologic remission is increasingly explored as an important endpoint in ulcerative colitis (UC). We investigated combined endoscopic‐histologic remission for predicting clinical outcomes at 12 months compared with endoscopic remission alone using the high definition virtual chromoendoscopy (VCE) Paddington International virtual ChromoendoScopy ScOre (PICaSSO) and histology scores. Methods Ulcerative colitis patients, prospectively enrolled from 11 international centres, underwent VCE with targeted biopsies and followed up for 12 months. Endoscopic activity was assessed by Mayo Endoscopic Score (MES), Ulcerative Colitis Endoscopic Index Severity (UCEIS) followed by VCE‐PICaSSO. Robarts Histopathological Index|Robarts Histological index≤3 without neutrophils in mucosa, and Nancy Histological index (NHI)≤ 1 were used to define histologic remission. Combined endoscopic‐histologic remission was compared with endoscopic remission alone by Cox proportional hazards model and by two‐ and three‐proportion analysis using pre‐specified clinical outcomes. Results 307 patients were recruited and 302 analysed. There was no difference in survival without specified clinical outcomes between PICaSSO defined endoscopic remission alone and endoscopic plus histologic remission in the rectum (HR 0.42, 95%CI 0.16‐1.11 and HR 1.03, 95%CI 0.42‐2.52 for Robarts Histological index and NHI respectively) at 12 months. There was however a significant survival advantage without specified clinical outcome events for UCEIS combined with histology compared with UCEIS alone (HR 0.30, 95%CI 0.12‐0.75, p = 0.02) at 12 months (but not combined with NHI). For MES there was no advantage for predicting specified clinical outcomes at 12 months for endoscopy alone versus endoscopy plus histology, but there were differences in two and three proportion analysis at 6 months. Conclusion Endoscopic remission by VCE‐PICaSSO alone was similar to combined endoscopic and histologic remission for predicting specified clinical outcomes at 12 months. Larger studies with specific therapeutic interventions are required to further confirm the findings.

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Defining Faecal Calprotectin Thresholds as a Surrogate for Endoscopic and Histological Disease Activity in Ulcerative Colitis—a Prospective Analysis

Cited by 59 publications

References 50 publications

Review article: faecal calprotectin and histologic remission in ulcerative colitis

Review article: faecal calprotectin and histologic remission in ulcerative colitis

Evaluation of a fluorescent immunochromatography test for fecal calprotectin

PICaSSO virtual electronic chromendoscopy accurately reflects combined endoscopic and histological assessment for prediction of clinical outcomes in ulcerative colitis

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