Young Investigator: Correlation of Fecal Calprotectin With Acute Phase Reactants (ESR, CRP) in Mexican Patients With Ulcerative Colitis

Abstract

BACKGROUND: Ulcerative Colitis (UC) gastrointestinal symptoms have an adequate correlation with endoscopic and biochemical parameters in patients with severe activity. However, the evaluation in patients with clinical remission is insufficient. Fecal calprotectin (FC) is effective in these scenarios, which is a fast and non-invasive test with high sensitivity and specificity. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used in conjunction with FC to assess disease activity, predict and monitor response to treatment. Objective: To evaluate the correlation of FC with ESR, CRP and clinical activity of patients with UC and its possible association with different clinical, endoscopic and histological outcomes. METHODS: Observational cross-sectional study. All patients in which who were measured in the INCMNSZ's Intestinal Inflammatory Disease Clinic during the period from August 2016 to June 2017 were included. Demographic, clinical, endoscopic and histological variables were collected. We used the criteria of Truelove and Witts for the evaluation of clinical remission or UC activity. Data analysis was performed through the statistical program SPSS version 24. RESULTS: A total of 127 patients with a histopathological diagnosis of UC were evaluated, of which 63 (49.2%) were women and 64 (50.8%) were men, with a mean age at diagnosis of 44.2 ± 14.9 years and a median evolution of 7 years. In 100 patients (61.1%) they had pancolitis (E3); 17 (9.9%) left colitis (E2) and 10 patients (6.2%) with proctitis (E1). In 93 (73.8%) they were being treated with 5-aminosalicylates; 14 (11.1%) with immunomodulators; 19 (15.1%) with steroids and 3 (2.4%) with anti-TNF biological therapy. The median fecal calprotectin was 306 ug / g (range: 30-1000). CF levels were elevated with a median of 276.5 ug / g in patients with clinical remission. The levels of CF, ESR and CRP according to clinical activity are shown in Table 1. The correlation between CF and ESR was low (R=0.21, P=0.006) as well as between CF and CRP (R=0.10, P=0.18). CF> 250 ug / g was significantly associated with extraintestinal manifestations (P=0.01, odds ratio=3.3, 95% CI: 1.2 -8.1) CONCLUSION(S): The correlation between ESR and CRP with CF levels was low suggesting that they are not adequate parameters for the adequate assessment of activity in asymptomatic patients. Fecal calprotectin> 250 was associated with the presence of extra intestinal manifestations.