High Percentage of IBD Patients with Indefinite Fecal Calprotectin Levels: Additional Value of a Combination Score

Abstract

Background and AimMonitoring mucosal inflammation in inflammatory bowel disease (IBD) is of major importance to prevent complications and improve long-term disease outcome. The correlation of clinical activity indices with endoscopic disease activity is, however, moderate. Fecal calprotectin (FC) is a better predictor of mucosal inflammation, but values between 100 and 250 µg/g are difficult to interpret in clinical practice. We aimed to evaluate the occurrence of indefinite FC levels in a real-life IBD cohort and study the additional value of a combination of biochemical markers and clinical activity indices.MethodsIn total, 148 Crohn’s disease (CD) and 80 ulcerative colitis (UC) patients visiting the outpatient clinic were enrolled. FC, clinical disease activity scored by the Harvey–Bradshaw index or Simple Clinical Colitis Activity Index, and C-reactive protein (CRP) were assessed. In a subset of patients, endoscopic activity was scored by the simple endoscopic score-Crohn’s disease and Mayo endoscopic subscore. Clinical activity index, CRP, and FC were integrated in a combination score and compared with endoscopy.ResultsIndefinite FC values were present in 24% of CD and 15% of UC. In the cohort of patients with endoscopy scores available, the combination score predicted endoscopic disease activity in CD with a sensitivity of 83% and specificity of 69% [positive predictive value (PPV) 58%, negative predictive value (NPV) 89%]. In UC, this was 88 and 75% (PPV 93%, NPV 60%).ConclusionsA combination of FC with clinical activity indices or CRP may aid in classifying patients with indefinite disease activity according to FC alone.

Fecal Eosinophil Cationic Protein Is a Diagnostic and Predictive Biomarker in Young Adults with Inflammatory Bowel Disease

“…However, this pattern was not unique to fECP considering that a similar picture was found for fCal and serum CRP. The fact that inflammatory biomarkers poorly correlate with clinical activity scores, particularly in patients with CD, has also been reported by other studies [6,43]. The most likely causes of this effect are symptoms related to non-inflammatory structural changes of the intestine such as scarring, strictures, adhesions in later stages of the disease or presence of bile acid stricture in post-surgical patients.…”

“…Clinical follow-up data was available for 202/212 visits (95.3%) of patients with IBD. The median (IQR) follow-up time was 48 (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54) months. The total event rate was 94/202 (46.5%).…”

Clinical, endoscopic and histological correlation and measures of association in ulcerative colitis

“…Nevertheless, there were two patients with fecal calprotectin close to 20 μg/g who also exhibited active microscopic inflammation in their biopsies, which may reflect a flaw in the sensitivity of fecal calprotectin. A recent publication calculated the diagnostic accuracy of fecal calprotectin >250 μg/g for the prediction of active endoscopic disease or remission and found that the sensitivity, specificity, positive predictive value and negative predictive value were 86%, 78%, 97% and 46%, respectively …”

“…A recent publication calculated the diagnostic accuracy of fecal calprotectin >250 μg/g for the prediction of active endoscopic disease or remission and found that the sensitivity, specificity, positive predictive value and negative predictive value were 86%, 78%, 97% and 46%, respectively. 39 The limitations of this study included the small sample size and the limited number of patients with Mayo endoscopic subscore of 0-1. Another limitation was the lack of fecal calprotectin in all the procedures evaluated, enabling us to perform the Spearman's correlation and the univariate and multivariate analyses.…”

Clinical Parameters Correlate With Endoscopic Activity of Ulcerative Colitis: A Systematic Review

“…Active vs inactive disease. Overall, 8 studies only included patients with active disease (Lewis et al, 19 Dhanda et al, 20 Jharap et al, 21 Scaioli et al, 23 Seo et al, 3 Achitei et al, 24 Mirpour et al, 25 Jairath et al 1 ), whereas 15 studies included patients with both active and inactive disease (Bodelier et al, 26 Schoepfer et al, 27 Pagnini et al, 28 Beattie et al, 7 Azzolini et al, 12 Hirai et al, 29 Langhorst et al, 30 Arai et al, 31 Higging et al, 32 Ricanek et al, 33 Samuel et al, 34 Taleban et al, 35 Falvey et al, 36 Chen et al, 37 and Colombel et al 22 ). Unfortunately, the published data do not provide information for active vs inactive disease separately.…”