Fecal Calprotectin for predicting Relapse and Activity in Patients with Crohn's Disease: A Meta-analysis.

Ying Zhuge,Qing Li,Jun-Shan Wang,Qiu-Ping Huang

doi:10.5005/jp-journals-10018-1182

Abstract

ABSTRACTAimsWe aimed to perform a meta-analysis of the predictive capacity of fecal calprotectin (FC) in activity and relapse of Crohn’s disease (CD).Materials and methodsMEDLINE, EMBASE, and the Cochrane Library databases were searched systematically. Pooled sensitivity, specificity, and other diagnostic indices were evaluated.ResultsA total of 1,252 CD patients from 18 different studies were analyzed. The pooled sensitivity and specificity of FC at a cutoff value of 50 μg/g to predict activity of CD were 0.91 [95% confidence interval (CI): 0.87–0.95] and 0.47 (95% CI: 0.35–0.59) respectively. The pooled sensitivity and specificity of FC at a cutoff value of larger than 150 μg/g to monitor relapse of CD was 0.75 (95% CI: 0.67–0.82) and 0.71 (95% CI: 0.66–0.76) respectively. The area under the summary receiver operating characteristic (SROC) curve of FC for detecting CD activity was 0.78 (50 μg/g), 0.88 (100 μg/g), 0.85 (>150 μg/g), and the diagnostic odds ratio (DOR) was 10.21 (50 μg/g), 10.20 (100 μg/g), 11.68 (>150 μg/g) respectively.ConclusionAs a simple and noninvasive marker, FC is useful to predict the activity and relapse in CD patients, and the capacity of FC to predict CD activity was superior to its application in monitoring relapse of CD.How to cite this articleZhuge Y, Huang Q-P, Li Q, Wang J-S. Fecal Calprotectin for predicting Relapse and Activity in Patients with Crohn’s Disease: A Meta-analysis. Euroasian J Hepato-Gastroenterol 2016;6(2):116-124.

Highlights

Crohn’s disease (CD) is one of the major forms of idiopathic inflammatory bowel disease (IBD).[1]
During the process of full-text review and data extraction, another 39 studies were excluded: 12 studies were not relevant studies; 11 studies were excluded as they were reporting clinical treatment outcome instead of predicting CD activity or relapse; 6 studies were excluded as concentrations of fecal calprotectin (FC) used for prediction were insufficient; 3 studies were excluded as the patients overlapped with another study; 5 studies were excluded as they were review papers; and 2 studies were discarded as it was performed in pediatric patients
The findings of our meta-analysis proved that FC at different cutoff values is not highly accurate for CD activity, pooled sensitivity is around 0.75, and summary specificity is between 0.47 and 0.78

Summary

Introduction

Crohn’s disease (CD) is one of the major forms of idiopathic inflammatory bowel disease (IBD).[1] Crohn’s disease is a chronic inflammatory disorder of the gastrointestinal tract, i.e., characterized by unknown etiology, accompanied with recurrent exacerbations and remissions. Medical intervention of CD includes conventional treatment, such as corticosteroids, immunomodulators, and biological agents. As tumor necrosis factor (TNF) is an important mediator of the development of CD in the digestive tract, biological agents, such as infliximab and adalimumab, targeting TNF, have remarkably improved the outcome of CD patients in recent years.[3] despite these improvements in the treatment of CD, there is still subclinical inflammation in the gut, leading to higher risk of relapse or recurrence.[2,3,4] monitoring the activity of inflammation and identifying patients who may benefit most from conventional or biological therapy are of great interest. These information are not always in accordance with the actual condition of CD due to the insufficient correlation between items of examination and disease pathology

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Discussion

Conclusion