Abstract
The clinical course of ulcerative colitis (UC) is featured by remission and relapse, which remains unpredictable. Recent studies revealed that fecal calprotectin (FC) could predict clinical relapse for UC patients in remission, which has not yet been well accepted. To detect the predictive value of FC for clinical relapse in adult UC patients based on updated literature, we carried out a comprehensive electronic search of PubMed, Web of Science, Embase, and the Cochrane Library to identify all eligible studies. Diagnostic accuracy including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and pooled area under the receiver operating characteristic (AUROC) was calculated using a random effects model. Heterogeneity across studies was assessed by the I2 metric. Sources of heterogeneity were detected using subgroup analysis. Metaregression was used to test potential factors correlated to DOR. Publication bias was assessed using Deek's funnel plots. In our study, 14 articles enrolling a total of 1110 participants were finally included, and all articles underwent a quality assessment. Pooled sensitivity, specificity, PLR, and NLR with 95% confidence intervals (CIs) were 0.75 (95% CI: 0.70–0.79), 0.77 (95% CI: 0.74–0.80), 3.45 (95% CI: 2.31–5.14), and 0.37 (95% CI: 0.28–0.49) respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.82, and the diagnostic odds ratio was 10.54 (95% CI: 6.16–18.02). Our study suggested that FC is useful in predicting clinical relapse for adult UC patients in remission as a simple and noninvasive marker.
Highlights
Ulcerative colitis (UC), one subtype of inflammatory bowel disease (IBD), which is characterized by chronic mucosal inflammation, affects more than 1 million people in the United States and Europe [1, 2]
The pooled positive likelihood ratio (PLR) was 3.45, negative likelihood ratio (NLR) was 0.37, and diagnostic odds ratio (DOR) was 10.54 (Table 2)
Our study revealed that fecal calprotectin (FC) yielded a good prediction value for the clinical relapse of UC
Summary
Ulcerative colitis (UC), one subtype of inflammatory bowel disease (IBD), which is characterized by chronic mucosal inflammation, affects more than 1 million people in the United States and Europe [1, 2]. The clinical course of UC is featured by remission and relapse, which remains unpredictable [6]. Uncertain clinical recurrence will affect the life quality of UC patients and require extended therapy as well as extra medical costs [7]. If we were able to identify patients with a high risk of clinical flare-up, adjusted treatment at a presymptomatic stage could be carried out. An earlier prediction of possible relapse is urgently needed for clinical physicians. A simple, reliable, and readily available test is needed to detect an imminent flare for timely escalation of treatment and better disease control
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