Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents

Hukkinen, Maria; Pakarinen, Mikko P.; Merras‐Salmio, Laura; Koivusalo, Antti; Rintala, Risto; Kolho, Kaija‐Leena

doi:10.1016/j.jpedsurg.2016.01.017

Cited by 24 publications

(18 citation statements)

References 43 publications

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“…A final nine studies met inclusion criteria (Figure 1), published between 2006 and 2016. Studies were excluded for the following reasons: pediatric population, 41,42 published as a letter, 29 nonuse of RS, 15,43 metaanalysis, 22 small sample size (n < 15), 44,45 insufficient data regarding FC results despite repeated efforts and contact with study authors 25 (TOPPIC) and extension of previously reported results. 32 Of the nine included studies, most were of European origin apart from one study from Australia 31 and another from Japan.…”

Section: Resultsmentioning

confidence: 99%

“…In a recent pediatric study, an FC increase of 79 μg/g compared with the first postoperative value was suggestive of endoscopic recurrence. 42 There are some limitations to our work, most of which are inherent to all diagnostic meta-analyses. Although there was some variability in the diagnostic techniques used across the included studies, importantly, all the included studies utilized quantitative ELISA calprotectin assays.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent pediatric study, an FC increase of 79 μg/g compared with the first postoperative value was suggestive of endoscopic recurrence. 42 …”

Section: Discussionmentioning

confidence: 99%

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Fecal calprotectin for detection of postoperative endoscopic recurrence in Crohn’s disease: systematic review and meta-analysis

Tham

Yung

Fay

et al. 2018

Therap Adv Gastroenterol

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Background:Anastomotic recurrence is frequent in patients with Crohn’s disease (CD) following ileocecal resection. The degree of endoscopic recurrence, quantified by the Rutgeerts score (RS), correlates with risk of clinical and surgical recurrence. Several studies demonstrate the accuracy of fecal calprotectin (FC) for detection of endoscopic recurrence, however the optimal threshold FC value remains to be established. The aim of our meta-analysis was to evaluate the accuracy of common FC cut-offs for detection of endoscopic recurrence.Methods:We performed a systematic literature search for studies evaluating postoperative recurrence in CD which reported RS and FC levels. Endoscopic recurrence was defined as RS = 2–4 (or RS ⩾ 2). We calculated pooled diagnostic sensitivity, specificity, diagnostic odds ratio (DOR) and constructed summary receiver operating characteristic (SROC) curves for each available FC cut-off value.Results:A total of 54 studies were retrieved; 9 studies were eligible for analysis. Diagnostic accuracy was calculated for FC values of 50, 100, 150 and 200 µg/g. A significant threshold effect was observed for all FC values. The optimal diagnostic accuracy was obtained for FC value of 150 µg/g, with a pooled sensitivity of 70% [95% confidence interval (CI) 59–81%], specificity 69% (95% CI 61–77%), and DOR 5.92 (95% CI 2.61–12.17). The area under the SROC curve was 0.73.Conclusion:FC is an accurate surrogate marker of postoperative endoscopic recurrence in CD patients. The FC cut-off 150 μg/g appears to have the best overall accuracy. Serial FC evaluations may eliminate or defer the need for colonoscopic evaluation in up to 70% of postoperative CD patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fecal calprotectin for detection of postoperative endoscopic recurrence in Crohn’s disease: systematic review and meta-analysis

Tham

Yung

Fay

et al. 2018

Therap Adv Gastroenterol

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“…Two studies that were not included in this latest meta-analysis, due to being performed in a paediatric population and published afterwards, similarly reported low values of specificity and different optimal cut-off values. The optimal cut-off point in detecting endoscopic recurrence in paediatric CD patients was 139 μg/g, which provided a sensitivity of 0.73, a specificity of 0.64, and an NPV of 70% [72]. The most recent study on this topic estimated an optimal cut-off point of 62 μg/g, with FCAL showing a sensitivity of 0.86, a specificity of 0.46, and an NPV of only 71%, which were not better than CRP or a score of symptoms [73].…”

Section: Fcal To Detect Postoperative Endoscopic Recurrence In CDmentioning

confidence: 99%

Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations

Laserna-Mendieta

Lucendo

2019

Clinical Chemistry and Laboratory Medicine (CCLM)

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A growing body of evidence has been published about the usefulness of measuring calprotectin in faecal samples (FCAL) in inflammatory bowel disease (IBD) assessment, including diagnosis, monitoring of disease activity and relapse prediction. Several systematic reviews with meta-analyses compiling studies for each particular clinical setting have been carried out in recent years. Most of these were focused on the use of FCAL in IBD diagnosis and showed a relevant role for this marker in selecting patients with gastrointestinal symptoms who would not need a further examination by endoscopy. Although a lesser number of meta-analyses have been performed on the use of FCAL as a surrogate marker of disease activity, a close correlation between FCAL and endoscopic activity of IBD has been shown. With respect to the predictive capacity of FCAL for IBD relapse, a single meta-analysis published indicates that this role is more limited. Furthermore, FCAL thresholds vary considerably depending on the clinical setting and, what is more concerning, among different commercially available assays due to a lack of FCAL concentration interchangeability. Here, we summarise recent publications about the role and limitations of FCAL in IBD, with a special focus on meta-analyses, and give an overview of alternative faecal biomarkers.

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“…While FC has been studied extensively in disease diagnosis, responses to therapy and post-operative monitoring[12-16], there is a paucity of robust data evaluating the predictive role of FC for disease relapse in pediatric IBD patients in clinical disease remission. Studies in adults have shown that FC is an accurate marker of intestinal inflammation and provides a useful tool for predicting disease relapse in IBD patients in clinical remission[7,17,18].…”

Section: Introductionmentioning

confidence: 99%

Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn’s disease patients

Foster

Smyth

Lakhani

et al. 2019

WJG

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BACKGROUNDAsymptomatic children with Crohn’s disease (CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.AIMIn a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.METHODSIn this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn’s Disease Activity Index, C-reactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.RESULTS53 children were included and eighteen patients (34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median (interquartile range), relapse 723 μg/g (283-1758) vs 244 μg/g (61-627), P = 0.02]. Fecal calprotectin levels > 250 μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo (area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).CONCLUSIONRoutine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.

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Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents

Cited by 24 publications

References 43 publications

Fecal calprotectin for detection of postoperative endoscopic recurrence in Crohn’s disease: systematic review and meta-analysis

Fecal calprotectin for detection of postoperative endoscopic recurrence in Crohn’s disease: systematic review and meta-analysis

Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations

Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn’s disease patients

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