Factors Associated With Fecal Calprotectin Sample Collection Compliance: An IBD Center Quality Improvement Project

Abstract

INTRODUCTION Fecal calprotectin (Fcal) is a non-invasive, inexpensive biomarker of disease activity. However, patient compliance with this test is variable and incompletely described. We assessed compliance rates with Fcal tests and identified factors associated with non-compliance. METHODS A retrospective chart review of patients with IBD who had a Fcal test ordered through our center between August 2021 and December 2021 was conducted. Demographic, clinical, disease, and test-related information were recorded. Patients with incomplete Fcal orders were sent a survey to better understand their reasons for non- compliance. Simple statistical analysis, multivariable logistic regression, and Bayesian Factor Analysis were performed. RESULTS Of 303 patients, 165 (54.4%) had an order for Fcal. Of the Fcal tests ordered, 55 (33.3%) were not completed. Remission of IBD, no prior Fcal completion, and tests ordered at a distant site were all associated with test non-completion. A multivariable logistic regression revealed that history of a prior completed Fcal test is associated with subsequent test completion (OR = 8.3, 95% CI 1.9-35.5, p = 0.004). Patients who did not complete the test described the pandemic and third-party testing center issues as the most common reasons for non-compliance. CONCLUSIONS In this single center experience with Fcal testing in patients with IBD, we identified that a history of incomplete Fcal testing and distant location of the lab are significantly associated with non- completion of the test. We provide practical guidance for future utilization and compliance, including the impact of home-based testing.

Development of Luminescent Biosensors for Calprotectin

“…Currently, clinical testing for calprotectin levels relies on enzyme-linked immunosorbent assays (ELISAs), which require trained personnel and expensive equipment and are therefore limited to laboratory settings and less accessible to low-resource areas. Specifically, data collection of fecal calprotectin levels is usually impeded by low patient compliance to fecal immunochemical testing in general, and specifically among patients with IBD, , with the necessity of sample transportation to the clinic as a primary deterrent, , making monitoring disease progression and guiding management challenging for the physicians and their patients. Therefore, improved clinical tests, particularly point-of-care and even at-home testing, for calprotectin levels would be of high diagnostic value and clinical utility.…”