Fecal calprotectin is not superior to serum C-reactive protein or the Harvey–Bradshaw index in predicting postoperative endoscopic recurrence in Crohn’s disease

Abstract

Background Fecal calprotectin (FC) is a widely used noninvasive marker of gut inflammation that is associated with endoscopic severity in Crohn’s disease (CD). However, FC has been inconsistent in predicting postoperative recurrence of CD, and its utility in the postoperative setting remains unclear. Materials and methods Blood and fecal samples were collected in consecutively recruited patients with CD who had undergone ileocolonic resection and required a colonoscopy to assess postoperative recurrence, as defined by the Rutgeerts score (RS). Results A total of 86 patients were prospectively recruited at five centers. Overall, 49 (57%) had CD recurrence (RS≥i2). FC concentrations trended to increase with RS severity; FC median (interquartile range) was significantly higher in patients with endoscopic recurrence than those in endoscopic remission [172.5 (75–375) vs. 75 (36.5–180.5) μg/g, respectively]. The same occurred for C-reactive protein (CRP) [0.5 (0.1–0.95) vs. 0.1 (0.02–0.27)] mg/dl and the Harvey–Bradshaw index (HBI) [4 (2–7) vs. 1 (0–3.5)]. The three variables significantly correlated. The area under the curve to discriminate between patients in endoscopic remission and recurrence was 0.698 for FC, with 62 μg/g being the optimal cut-off point. This indicated FC would have 85.7% sensitivity and 45.9% specificity in detecting any recurrence, having positive predictive value and negative predictive value of 67.7 and 70.8%, respectively. Area under the curve for CRP and HBI were both 0.710. The combination of CRP and HBI provided a positive predictive value 95.7 and a diagnostic odds ratio of 30.8. Conclusion FC is not better than CRP combined with HBI to predict endoscopic postoperative recurrence of CD.

Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion

“…A Spanish group studied fecal calprotectin (FCP) levels in CD patients who had undergone ileocolonic resection. 17 In that study, the group with a Rutgeerts score of i2 had a median FCP level of 166. Thus, CD patients with active SB lesions can exhibit "Real Silent CD" coupled with a normal CRP or FCP range.…”

Effects of vedolizumab in Japanese patients with Crohn’s disease: a prospective, multicenter, randomized, placebo-controlled Phase 3 trial with exploratory analyses

“…However, these trials were assessed by conventional ileocolonoscopy, and there is a possibility that proximal ileal lesions can be missed with this technique [21,22]. Furthermore, endoscopic active ileal lesions are not always successfully identified by CDAI, or by assessment of biomarkers of CD severity, for instance CRP or fecal calprotectin [23]. Further research is needed to evaluate the efficacy of vedolizumab in ileal lesions by using capsule endoscopy or balloon-assisted enteroscopy.…”

Quality of care in inflammatory bowel disease: actual health service experiences fall short of the standards

“…13 Likewise, the Manitoba Index correlates highly with other common disease activity indices. 14 While these disease activity indices are subjective and therefore not universally reliable, research has shown that they correlate with objective markers of disease activity such as C-reactive protein 34 or faecal calprotectin, 35 although the correlations appear stronger using UC-specific rather than CD-specific indices, 36 and therefore can substitute objective measures when they are not attainable (e.g. online data collection).…”