Fecal calprotectin measurement is a marker of short-term clinical outcome and presence of mucosal healing in patients with inflammatory bowel disease

Abstract

AIMTo evaluate the utility of fecal calprotectin (FC) in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease (IBD) cohort.METHODSAll FC measurements that were obtained during a 3-year period from patients with inflammatory bowel disease in clinical remission were identified. Data regarding the short-term (6 mo) course of the disease were extracted from the medical files. Exclusion criteria were defined as: (1) An established flare of the disease at the time of FC measurement, (2) Loss to follow up within 6 mo from baseline FC measurement, and, (3) Insufficient data on file. Statistical analysis was performed to evaluate whether baseline FC measurement could predict the short term clinical relapse and/or the presence of mucosal healing.RESULTSWe included 149 [Crohn’s disease (CD) = 113, Ulcerative colitis (UC) = 36, male = 77] IBD patients in our study. Within the determined 6-month period post-FC measurement, 47 (31.5%) had a disease flare. Among 76 patients who underwent endoscopy, 39 (51.3%) had mucosal healing. Baseline FC concentrations were significantly higher in those who had clinical relapse compared to those who remained in remission during follow up (481.0 μg/g, 286.0-600.0 vs 89.0, 36.0-180.8, P < 0.001). The significant predictive value of baseline median with IQR FC for clinical relapse was confirmed by multivariate Cox analysis [HR for 100μg/g: 1.75 (95%CI: 1.28-2.39), P = 0.001]. Furthermore, lower FC baseline values significantly correlated to the presence of mucosal healing in endoscopy (69.0 μg/g, 30.0-128.0 vs 481.0, 278.0-600.0, in those with mucosal inflammation, median with IQR, P < 0.001). We were able to extract cut-off values for FC concentration with a high sensitivity and specificity for predicting clinical relapse (261 μg/g with AUC = 0.901, sensitivity 87.2%, specificity 85.3%, P < 0.001) or mucosal healing (174 μg/g with AUC = 0.956, sensitivity 91.9%, specificity 87.2%, P < 0.001). FC was better than CRP in predicting either outcome; nevertheless, having a pathological CRP (> 5 mg/L) in addition to the cut-offs for FC, significantly enhanced the specificity for predicting clinical relapse (95.1% from 85.3%) or endoscopic activity (100% from 87.2%).CONCLUSIONSerial FC measurements may be useful in monitoring IBD patients in remission, as FC appears to be a reliable predictor of short-term relapse and endoscopic activity.

Safety of P28GST, a Protein Derived from a Schistosome Helminth Parasite, in Patients with Crohn’s Disease: A Pilot Study (ACROHNEM)

“…To circumvent a potential placebo effect, a likely hypothesis in the absence of control group, these results were consolidated by measuring calprotectin. Although FC is the accepted marker of short-term clinical outcomes in IBD [12], we recognized that collecting stool samples was a hurdle for the patients, which could lead to many missing stool samples [22]. Therefore, we evaluated SC levels, and the results showed that SC levels decreased in parallel with CDAI scores at 3 and 12 months after P28GST treatment.…”

“…FC was measured in the central laboratory of Lille University Hospital, with a commercially available enzyme-linked immunoassay (ELISA) kit (EK-CAL, Bühlmann, Switzerland), according to the manufacturer instructions [12]. FC levels are expressed as µg/g of feces, and the normal range is FC < 50 µg/g.…”

Response to treatment is more important than disease severity at diagnosis for prediction of early relapse in new‐onset paediatric Crohn’s disease

“…Remission with normalisation of CRP following induction treatment has conversely been linked with favourable clinical outcomes, including sustained clinical remission …”

“…Remission with normalisation of CRP following induction treatment has conversely been linked with favourable clinical outcomes, including sustained clinical remission. 12,[32][33][34][35] Low PCDAI scores (<10) show only fair correlation with endoscopic healing and lower short-term risk of relapse/enhanced sustained remission. 31,36,37 A previous study reviewing 4 clinical trials indeed demonstrated that PCDAI <7.5 without the height component appears to be the better cutoff for clinical remission using physicians global assessment as a comparator for remission.…”

DIAGNOSTIC POSSIBILITIES OF FECAL CALPROTECTIN APPLICATION IN PATIENTS WITH INFLAMMATORY DOWEL DISEASES DURING PREGNANCY (literature review and clinical observations)

“…В недавно опубликованных результатах исследования Kostas A. и соавт. подтверждена высокая диагностическая ценность определения ФК у пациентов с ВЗК при краткосрочном прогнозировании реактивации воспалительного процесса (свыше 261 мкг/г с AUC=0,901, чувствительность 87,2%, специфичность 85,3%, P<0,001) и повреждения слизистой оболочки (свыше 174 мкг/г с AUC=0,956, чувствительность 91,9%, специфичность 87,2%, P<0,001) [22]. При этом ФК оказался более точным предиктором обострения, чем СРБ.…”