Fecal calprotectin as a noninvasive test to predict deep remission in patients with ulcerative colitis

Abstract

Mucosal healing (MH) has become a major target in the management of ulcerative colitis (UC). Because repeat endoscopy is expensive and invasive, we aimed to evaluate fecal calprotectin (FC) as an alternative marker to predict MH in UC. Eighty patients with UC in clinical remission were consecutively included in a prospective observational study. FC was measured using a quantitative enzyme-linked immunosorbent assay. The colonic mucosa was assessed for endoscopic and histological measures of inflammatory status. Endoscopic and histological remission were defined according to the Mayo endoscopic subscore (MES) and Geboes score (GS), respectively. Deep remission was defined as a combination of the MES and GS. FC performance and cutoff values for identifying MH and deep remission were determined using contingency tables and receiver operator characteristic (ROC) and area under the curve (AUC) analysis. The median FC concentration in patients who met the criteria for deep remission (MES ≤1 and GS < 3.1) was 65.5 μg/g, while that in patients with disease activity was 389.6 μg/g (P = .025). A FC cutoff value of 100 μg/g, determined by the ROC analysis, resulted in sensitivity and specificity of 91.7% and 57.1%, respectively, for histological remission, and 82.4% and 60.9%, respectively, for deep mucosal remission. Positive correlations were detected between FC concentrations with the histologic (CC: 0.435; P < .001) and the combined endoscopic and histologic (CC: 0.413; P < .001) scores. FC can be used confidently as a noninvasive biomarker to predict deep remission in patients with UC in clinical remission when concentrations are below 100 μg/g.

Importancia de la prueba de calprotectina fecal en la enfermedad inflamatoria intestinal

“…Una concentración baja de CF predice la persistencia de la remisión clínica, en especial en las úlceras asintomáticas de la CU. Se ha demostrado que la CF es un biomarcador útil de cicatrización de la mucosa intestinal 39 .…”

Advances of Heat Shock Family in Ulcerative Colitis

“…Fecal Calprotectin (FC), the other marker used to evaluate MH, has a particular value in predicting MH. Nevertheless, samples significantly affect their value, and the cut-off value used to assess MH in various studies also has significant differences ( Ricciuto and Griffiths, 2019 ; Malvão et al, 2021 ). Therefore, it is a potential research direction to explore new biomarkers from intestinal mucosal homeostasis protective factors to make up for the deficiency of endoscopy and FC in MH assessment.…”

Is histological remission of ulcerative colitis achievable?

“…В научных публикациях, посвященных изучению достижения гистологической ремиссии ВЗК, уделяется внимание анализу общепринятых гистологических критериев диагностики активности ВЗК у больных с эндоскопической ремиссией, определяемой как заживление слизистой оболочки кишки; выявлению статистически значимых корреляций между эндоскопической и гистологической активностью с концентрацией ФКП и другими иммунобиологическими маркерами [10,25,26]. Прогностическое значение заживления слизистой оболочки было впервые выявлено R. Wright и соавт.…”