Faecal Calprotectin Predicts Endoscopic and Histological Activity in Clinically Quiescent Ulcerative Colitis

Abstract

Introduction Faecal calprotectin [FC] is a reliable surrogate marker for disease activity in ulcerative colitis [UC]; however, there are no consensus cut-off values for remission. The study aim was to correlate FC with Mayo Endoscopic Score [MES] and histological disease activity of UC patients in clinical remission. Methods Our study recruited adult UC patients at the McGill IBD Center between 2013 and 2017. Patients in clinical remission [partial Mayo score ≤2], undergoing endoscopy for disease activity or dysplasia surveillance, were enrolled. Before bowel preparation, FC was collected. MES was documented during colonoscopy. Biopsies were taken; histological activity was assessed using Geboes score and the presence of basal plasmacytosis. Results A total of 185 patients were recruited. The area under the curve [AUC] in receiver operating characteristic [ROC] analysis to predict MES 1–3 [from 0] was 0.743 [95% CI 0.67–0.82; p <0.001] with an FC cut-off value 170 µg/g [64% sensitivity, 74% specificity], and to predict MES 2–3 [from 0–1] was 0.722 [95% CI 0.61–0.83; p <0.001] with an FC cut-off value 170 µg/g [69% sensitivity, 65% specificity]. To differentiate MES 0 from MES 1, an FC value 130 µg/g yields a 70% sensitivity and 68% specificity. The AUC in ROC analysis to predict Geboes <3.1 was 0.627 [95% CI 0.55–0.71; p = 0.003], with an FC value 135 µg/g [54% sensitivity, 69% specificity]. Conclusions In this large study, FC ≥170 µg/g predicts endoscopic activity and FC ≥135 µg/g predicts histological activity. Therefore in clinical practice, lower faecal calprotectin thresholds can be chosen to optimise identification of patients with ongoing endoscopic and histological disease activity.

Review article: faecal calprotectin and histologic remission in ulcerative colitis

“…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). Five studies assessed the correlation between FC and histology in patients with quiescent disease. Disease remission was defined by clinical scores or clinical scores combined with endoscopic ones and was different in each study.…”

“…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.…”

“…FC was analysed through different methods. Eight studies used the enzyme-linked immunosorbent assay (ELISA) test 13,15,[25][26][27]29,30,32 :…”

“…the Bühlmann kit (Switzerland) was adopted in six trials, 13,15,25,26,30,32 the Genova diagnostics kit (Asheville, NC) 29 in one trial and an unspecified kit in another one. 27 One study 31 analysis.…”

“…27 One study 31 analysis. [13][14][15][25][26][27][28][29][30][31][32][33] Seven studies 13,14,27,29,30,32,33 31 In the individual studies microscopic inflammation was found in a percentage of patients ranging from 11.6% to 57.1%, although they were considered in disease remission. Several FC cut-off points were found to predict the presence or absence of histologic activity with a high degree of accuracy.…”