Diagnostic accuracy of fecal calprotectin in predicting significant gastrointestinal diseases

Abstract

Background and Aim: It is often unreliable to triage patients for timely endoscopic investigations based on symptoms alone. We need an objective assessment to differentiate between organic gastrointestinal diseases and functional bowel symptoms. We evaluated the diagnostic accuracy of fecal calprotectin (FC) in predicting organic gastrointestinal diseases. Methods: In a prospective observational study, consecutive patients referred for colonoscopy to the Department of Medicine and Geriatrics at the Kwong Wah Hospital in Hong Kong were recruited. Stool samples were collected within 24 h before colonoscopy. FC was measured by a commercial kit. Upper endoscopy investigations were then proceeded if normal colonoscopy but elevated FC. Results: Two hundred and seventy out of 429 patients had FC above 50 μg/g. Eighty-six out of 270 with elevated FC had significant colonoscopy pathological findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FC test for diagnosing a significant organic colonoscopy or upper endoscopy disease were 91.7, 55.6, 57.0, and 91.2%, respectively. The NPV of FC for colorectal cancer, high risk polyp, and colon inflammation were 98.7, 96.2, and 98.1%, respectively. The NPV of FC in the condition of altered bowel habit or abdominal pain in predicting colorectal cancer and inflammation were 93.8 and 100%, respectively. Conclusions: FC is a reliable marker of ruling out organic bowel diseases. A single negative FC test could be used as a triage tool to prioritize the need and urgency of further investigation, particularly in the setting of altered bowel habits and abdominal pain.

Evaluación del valor diagnóstico de la calprotectina fecal en pacientes con dispepsia

“…La sensibilidad y la especificidad del nivel elevado de calprotectina fecal para los hallazgos significativos de la colonoscopia fueron 100 y 44.4%, respectivamente. Es decir, 100% de los pacientes con dolor abdominal tuvieron CF positiva, en contraparte nuestro estudio encontró solo el 48.57%, esto posiblemente al grupo mayor de población estudiada en el nuestro (Kan et al, 2021). Para esta investigación, se demostró que pacientes con niveles elevados de CF y sin patología endoscópica fueron el 13.2%.…”

Diagnostic value of fecal calprotectin in primary care patients with gastrointestinal symptoms: A retrospective Swedish cohort study

“…9,10 However, elevated FC has been ascribed to several other factors, including treatment with nonsteroidal antiinflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), or acetylsalicylic acid (ASA). 6,[11][12][13] Previous studies have confirmed elevated FC in 32-57% of the patients with normal colonoscopy 11,14,15 and found an association with these drugs. 11 The measures of FC test accuracy have mainly been performed in selected secondary care populations, and the evidence available from primary care is still limited.…”

“…However, elevated FC has been ascribed to several other factors, including treatment with nonsteroidal anti‐inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), or acetylsalicylic acid (ASA) 6,11–13 . Previous studies have confirmed elevated FC in 32–57% of the patients with normal colonoscopy 11,14,15 and found an association with these drugs 11 …”

Biomarkers to Detect Early-Stage Colorectal Cancer

“…Neutrophils play a major role in the release of calprotectin at sites of inflammation, and faecal calprotectin (FC) has long been considered a potential biomarker of colorectal polyps and cancer [ 33 ]. However, FC is shown to have limited diagnostic accuracy for identifying patients with CRC, irrespective of stage [ 33 , 34 , 35 , 36 , 37 ] and this is reinforced by studies that have compared the sensitivity and specificity of FC to quantitative FIT in this setting [ 21 , 23 , 30 , 38 , 39 ].…”

“…The benefit of measuring FC levels in stool samples of patients who present in primary care with symptoms may instead be linked to the negative predictive value (NPV) of the test in a CRC diagnostic setting. Studies to date report NPV between 97.2–98.7 for CRC, and 93.2–97.2 for high-risk adenomas [ 21 , 37 , 39 , 40 ]. NICE guidelines accept a 3% risk in missing CRC in setting symptom criteria for referral [ 41 ], leading to the suggestion that FC concentrations below an established threshold may help rule out younger patients who more commonly present with nonspecific lower GI symptoms [ 42 ].…”