Predictive Value Of Fecal Calprotectin Research Articles

Predictive value of fecal calprotectin and lactoferrin levels for negative outcomes in Clostridioides difficile infection.

We investigated the role of fecal calprotectin (FC) and lactoferrin (FL) as predictive biomarkers in Clostridioides difficile infection (CDI). We assembled a prospective cohort including all patients with a laboratory-confirmed CDI diagnosis between January and December 2017. FL and FC levels were measured at diagnosis by commercial ELISA and EIA kits. We investigated the diagnostic accuracy of FC and FL to predict CDI recurrence and severity (study outcomes) and explored optimal cut-off values in addition to those proposed by the manufacturers (200µg/g and 7.2µg/mL, respectively). We included 170 CDI cases (152 first episodes and 18 recurrences). The rates of recurrence (first episodes only) and severity (entire cohort) were 9.2% (14/152) and 46.5% (79/170). Both FL and FC levels were significantly higher in patients who developed study outcomes. Optimal cut-off values for FC and FL to predict CDI recurrence were 1052µg/g and 6.0µg/mL. The optimal cut-off value for FC yielded higher specificity (60.9%) and positive predictive value (PPV) (16.9%) than that proposed by the manufacturer. Regarding CDI severity, the optimal cut-off value for FC (439µg/g) also provided higher specificity (43.9%) and PPV (54.1%) than that of the manufacturer, whereas the optimal cut-off value for FL (4.6µg/mL) resulted in an improvement of PPV (57.5%). By modifying the thresholds for assay positivity, the measurement of FC and FL at diagnosis is useful to predict recurrence and severity in CDI. Adding these biomarkers to current clinical scores may help to individualize CDI management.

Predictive value of faecal calprotectin in ulcerative colitis – single centre experience

Objectives Faecal calprotectin is an important biomarker used in the evaluation of inflammatory bowel disease. The aim of this study was to establish the value of faecal calprotectin concentration as a predictor of remission in ulcerative colitis and its correlation with laboratory, endoscopic and clinical findings. Methods The single centre study included 126 adult patients with established diagnosis of ulcerative colitis consecutively visiting our Day clinic from March 2017 to March 2019. We measured serum biomarkers- CRP, haemoglobin, leukocytes and platelets. Faecal calprotectin was determined from stool, and endoscopy was performed with calculation of MAYO endoscopic subscore system (MES 0–1: remission, and MES 2–3: active disease). Clinical assessment was done by using Mayo score for ulcerative colitis (clinical Mayo score <2:remission, >5: active disease).The statistical analysis was performed using an univariate and multivariate model of disease remission prediction using logistic regression. Results According to univariate analysis the increase of faecal calprotectin concentration by 10 ug/g is associated with an 8% decrease in probability of disease remission (OR 0.9921, p < .05). In the multivariate analysis, faecal calprotectin remained a significant predictor of disease remission (OR 0.9948, 95% CI 0.9914–0.9982, p = .0028), however, with a significant contribution of C-reactive protein (OR 0.8340, 95% CI 0.7085–0.9818, p = .0292). According to our model the cut off value for faecal calprotectin was 154 ug/g. Conclusion Our results have shown that faecal calprotectin is an independent predictor of remission in UC patients. The results of our study represent real-life data from a single university centre dealing with FC as a prognostic marker in patients with UC. KEY MESSAGES Faecal calprotectin is an independent predictor of remission in UC patients. Recent studies have suggested that calprotectin correlates well with endoscopic activity of inflammation but correlation of faecal calprotectin in a phase of remission hasn’t been evaluated yet. We have found that other inflammatory biomarkers do not correlate well with either endoscopic or clinical activity in ulcerative colitis.

The diagnostic and predictive value of fecal calprotectin and capsule endoscopy for small-bowel Crohn's disease: a systematic review and meta-analysis.

there are no clarified non-invasive methods to evaluate small bowel inflammation in Crohn's disease. to evaluate the accuracy of fecal calprotectin and capsule endoscopy for the diagnosis of small bowel Crohn's disease and to predict relapse. a systematic literature search was performed for studies to diagnose and predict relapse of the disease with fecal calprotectin and capsule endoscopy. The relevant pooled data including sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, negative likelihood ratio and area under curve were calculated using Stata 14.0. twenty-one studies were included in the final analyses. The diagnostic accuracy of the disease and relapse were obtained for capsule endoscopy, with a pooled sensitivity of 0.90 and 0.82, specificity of 0.76 and 0.56, diagnostic odds ratio of 33 and 6, and area under curve of 0.92 and 0.82, respectively. Diagnostic accuracy of the disease was calculated for fecal calprotectin values of 50, 100 and 200 ug/g; the sensitivity values were 0.84, 0.66 and 0.45; specificity values were 0.49, 0.74 and 0.87; diagnostic odds ratio were 5, 5 and 5; and area under curve were 0.74, 0.76 and 0.75, respectively. A fecal calprotectin level of 100-140 ug/g for the prediction of relapse had a pooled sensitivity of 0.68, specificity of 0.91, diagnostic odds ratio of 21, and area under curve of 0.77. capsule endoscopy is effective in diagnosing small bowel Crohn's disease and predicting relapse. Fecal calprotectin is an accurate surrogate technique to diagnose small bowel inflammation in Crohn's disease. Furthermore, the best scenario for fecal calprotectin is the prediction of relapse.

Fecal calprotectin is a strong predictive marker of relapse in Chinese patients with Crohn’s disease: a two-year prospective study

Objective: To evaluate the predictive value of fecal calprotectin (FC) for clinical relapse in Chinese patients with quiescent Crohn’s disease (CD) and to further investigate the correlation between FC and intestinal inflammation.Methods: Sixty-two patients with a diagnosis of quiescent CD were consecutively enrolled in this prospective study. Fecal samples were collected and enteroscopy were performed to detect mucosal lesions at the beginning of the study. Patients were followed until the first relapse or by the end of the two-year follow-up. The calprotectin concentration was measured using a quantitative enzyme-linked immunoassay.Results: Of the 62 CD patients, 29 had a relapse (median time of relapse: 8.44 months). The median follow-up months was 8.16 (4.98–13.59). The cut off level of 225 μg/g provided the maximal area under the receiver operating characteristic curve (AUC) of .775 for detecting the relapse of CD patients. Meanwhile, fecal occult blood had an added value. The multivariate Cox regression model showed that FC was the strongest predictor of the risk of relapse (risk ratio (RR): 6.315; p = .001). FC correlated most closely with the simple endoscopic score for Crohn’s disease (SES-CD) (r = 0.524, p < .001).Conclusions: FC correlated significantly with gut inflammation and could be a reliable predictor of relapse in Chinese patients with CD.

Raised faecal calprotectin is associated with subsequent symptomatic relapse, in children and adolescents with inflammatory bowel disease in clinical remission.

Reliable data on inflammatory biomarkers for predicting relapse of paediatric inflammatory bowel disease (IBD) are lacking. To investigate the predictive value of faecal calprotectin (FC) and CRP for symptomatic relapse in pediatric IBD in clinical remission. In this cross-sectional cohort study, patients <18 years with Crohn's disease or ulcerative colitis in clinical remission ≥3 months were included. At baseline, clinical and biochemical disease activity were assessed using the abbreviated-Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index, and FC and CRP respectively. Disease course over the subsequent 12 months was retrospectively assessed. In total, 114 patients (56% males; median age 14.9 years) were included. Baseline FC was higher in patients that developed symptomatic relapse [median (IQR), relapse 370 μg/g (86-1100) vs. remission 122 μg/g (40-344), P = 0.003]. Baseline FC was predictive of symptomatic relapse within 6 months [HR per 250 μg/g (95% CI): 1.46 (1.21-1.77), P < 0.001], with good predictive accuracy (AUC: 0.82). Optimal FC cut-off was 350 μg/g, with positive and negative predictive value of 41% and 96%. Baseline CRP was higher in patients that developed symptomatic relapse [median (IQR), relapse 1.0 μg/g (0.6-5.0) vs. remission 1.0 μg/g (0.4-2.0), P = 0.033]. Baseline CRP was predictive of symptomatic relapse within 6 months from baseline [HR per 1 mg/L (95% CI): 1.10 (1.02-1.19), P = 0.011], with fair predictive accuracy (AUC: 0.72). Optimal CRP cut-off was 1.0 mg/L, with positive and negative predictive value of 21% and 94%. Faecal calprotectin and CRP are predictive of symptomatic relapse and may be valuable in management of paediatric IBD in clinical remission.

Comment on "Biomarkers as Potential Treatment Targets in Inflammatory Bowel Disease: A Systematic Review".

We read with interest the article entitled “Biomarkers as Potential Treatment Targets in Inflammatory Bowel Disease: A Systemic Review,” which brings forward evidence that serum and faecal biomarkers do not possess adequate operational characteristics to make them stand-alone treatment targets in inflammatory bowel disease (IBD) but should be considered as important adjunctive measures to clinical, endoscopic, and radiographic assessment [1]. We recently carried out a study at Mater Dei Hospital, Malta, where we compared the positive predictive value of faecal calprotectin (FC) in patients with newly diagnosed inflammatory bowel disease (IBD), compared to the more widely used erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Our patient population consisted of 97 patients with a histological diagnosis of IBD and in whom all three biomarkers (FC, ESR, and CRP) were taken. All faecal calprotectin values were positive (with a mean average of 807 mg/L; normal < 50 mg/L). ESR was only elevated in 45% of cases while CRP was elevated in only 21% of cases. From the 97 patients; 60 were diagnosed with Crohn's disease (CD), 34 with ulcerative colitis (UC), and 3 with indeterminate IBD. The mean FC level, ESR, and CRP were 857 mg/L, 37 mm/hr, and 30 mg/L in CD; 771 mg/L, 39 mm/hr, and 62 mg/L in UC; 180 mg/L, 40 mm/hr, and 23 mg/L in indeterminate IBD. There was no statistical significance between the adult and paediatric populations. These results demonstrate and confirm that ESR and CRP are poor markers of intestinal inflammation, when compared to faecal calprotectin. This data suggests that all IBD patients should have a faecal calprotectin measured at outpatients rather than ESR and CRP in order to assess clinical activity even in the absence of gastrointestinal symptoms. The role of FC in the investigation and management of gastrointestinal pathologies has been on the increase. Nowadays faecal calprotectin is playing a major role in the investigation and diagnosis of patients presenting to the physician with lower gastrointestinal symptoms. When taken appropriately a negative faecal calprotectin would rule out IBD thus sparing most people with irritable bowel syndrome from having costly and invasive investigations [2]. Faecal calprotectin has been demonstrated to correlate better with endoscopic disease activity than clinical activity, CRP, platelets, haemoglobin, and blood leukocytes. Furthermore, the strong correlation of faecal calprotectin with endoscopic disease activity suggested that calprotectin is indeed a useful biomarker for the noninvasive monitoring of disease activity in patients [3]. FC is also useful in predicting the probability of relapses in both quiescent ulcerative colitis and quiescent Crohn's disease [4, 5]. Thus in the context of the ever-increasing financial burden on the health services and the better performance of FC as a biomarker, ESR and CRP should only be requested in exceptional circumstances.

Usefulness of a rapid faecal calprotectin test to predict relapse in Crohn’s disease patients on maintenance treatment with adalimumab

Background and aim Predicting relapse in Crohn’s disease (CD) patients by measuring non-invasive biomarkers could allow for early changes of treatment. Data are scarce regarding the utility of monitoring calprotectin to predict relapse. The aim of the study was to evaluate the predictive value of a rapid test of faecal calprotectin (FC) to predict for flares in CD patients on maintenance treatment with adalimumab (ADA). Methods A prospective, observational cohort study was designed. Inclusion criteria were CD patients in clinical remission on a standard dose of ADA therapy. Fresh FC was measured using a rapid test. Results Thirty patients were included (median age 38 years, 56.7% female). After the 4 months follow-up, 70.0% patients remained in clinical remission and 30.0% had a relapse. FC concentration at inclusion was significantly higher in those patients who relapsed during the follow-up (625 μg/g) compared to those who stayed in remission (45 μg/g). The optimal cut-off for FC to predict relapse was 204 μg/g. The area under the receiver-operating characteristic curve was 0.968. Sensitivity, specificity, positive, and negative predictive value of FC to predict relapse were 100%, 85.7%, 74.1%, and 100%, respectively. Conclusion In CD patients on ADA maintenance therapy, FC levels measured with a rapid test allow relapse over the following months to be predicted with high accuracy. Low FC levels exclude relapse within at least 4 months after testing, whereas high levels are associated with relapse in three out of every four patients.

Fecal calprotectin is a useful marker to diagnose ulcerative colitis from irritable bowel syndrome.

Background:This study was aimed to evaluate the predictive value of fecal calprotectin in patients with ulcerative colitis from patients with irritable bowel syndrome (IBS).Materials and Methods:Between May and October 2013, 88 adult patients, between the age 18 and 65 years with a history of chronic diarrhea of unknown origin were assessed. Standard colonoscopies were performed in all patients to assess ulcerative colitis. Before colonoscopies, they were asked to supply a stool specimen. Fecal calprotectin value was measured using a commercial enzyme-linked immunosorbent assay kit.Results:The mean of age, gender combination, and body mass index were not significantly different between patients with ulcerative colitis or IBS. The duration of disease in ulcerative colitis patients was significantly higher than IBS patients (P < 0.0001). The level of calprotectin in ulcerative colitis patients was significantly higher than IBS patients (265.9 vs 115.8, respectively, P = 0.001). Also, cutoff value >164 μg/g with sensitivity and specify of 57 (CI: 41%–71.6%), and 75 (CI: 59.7%–56.8%), respectively, was the best for discrimination between patients with ulcerative colitis and those with IBS.Conclusion:Our results show that fecal calprotectin as a noninvasive method, which can be used to identify patients with ulcerative colitis from IBS patients has low sensitivity and specificity.

A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn's disease

BackgroundFaecal calprotectin (FC) is a non-invasive marker of gastrointestinal inflammation. AimTo determine whether higher FC levels in individuals with quiescent Crohn's disease are associated with clinical relapse over the ensuing 12months. MethodsA single centre prospective study was undertaken in Crohn's disease patients in clinical remission. The receiver operating characteristic (ROC) curve for the primary endpoint of clinical relapse by 12months, based on FC at baseline, was calculated. Kaplan–Meier curves of time to relapse were based on the resulting optimal FC cutoff for predicting relapse. ResultsOf 97 patients recruited, 92 were either followed up for 12months without relapsing, or reached the primary endpoint within that period. Of these, 10 (11%) relapsed by 12months. Median FC was lower for non-relapsers, 96μg/g (IQR 39–237), than for relapsers, 414μg/g (IQR 259–590), (p=0.005). The area under the ROC curve to predict relapse using FC was 77.4%. An optimal cutoff FC value of 240μg/g to predict relapse had sensitivity of 80.0% and specificity of 74.4%. Negative predictive value was 96.8% and positive predictive value was 27.6%, FC≥240μg/g was associated with likelihood of relapse by 12-months 12.18 (95%CI 2.55–58.2) times higher than lower values (p=0.002). ConclusionsIn this prospective dataset, FC is a useful tool to help identify quiescent Crohn's disease patients at a low risk of relapse over the ensuing 12months. FC of 240μg/g was the optimal cutoff in this cohort.

P108 Towards patient-reported disease severity index in inflammatory bowel disease

Background: Predicting relapse in Crohn’s disease (CD) patients by measuring non-invasive biomarkers could allow for early changes of treatment. Data are scarce regarding the usefulness of monitoring with calprotectin to predict relapse. The aim of the study was to evaluate the predictive value of a rapid test of fecal calprotectin to predict for flares in CD patients under maintenance treatment with adalimumab (ADA). Methods: A prospective, observationalcohort study was designed. Inclusion criteria were CD patients in clinical remission for at least six months under a continuous standard dose of 40mg/eow ADA therapy. Fresh faecal calprotectin was measured using a rapid test (Quantum blue®) on the day of the first ADA injection. Quantum blue ®is a rapid test for measuring calprotectin in less than half an hour. Clinical examination was performed during the following 4 months. Relapse was defined as a Harvey Bradshaw score >4. Results are shown as mean±SD and compared by the U-Mann Whitney test. ROC analysis was performed and the diagnostic accuracy was calculated. Results: Thirty patients were included (mean age 40 years, 56.7% female). After the four months follow-up, twentyone (70.0%) patients remained in clinical remission and nine (30.0%) have had a relapse. Fecal calprotectin concentration at inclusion was significantly higher in those patients who relapsed during the follow-up (803±514mg/g) than in those who maintained in remission (95±104mg/g) (p < 0.005). The optimal cut-off of fecal calprotectin to predict remission was 204mg/g according to the ROC analysis. The area under the ROC curve was 0.97 (p < 0.005). Sensitivity, specificity, positive and negative predictive value of fecal calprotectin to predict relapse were 100%, 85.7%, 74.1% and 100%, respectively. Levels of calprotectin were correlated with levels of C-reactive protein (r = 0.51, P< 0.005). After multiple linear regression, we observed that if we made adjustments with other relevant sociodemographic and clinical variables, calprotectin and older age were the most important risk factors for the presence of relapse. Conclusions: In CD patients under ADA maintenance therapy, fecal calprotectin levels allow predicting relapse over the following months with a high accuracy. Low fecal calprotectin levels exclude relapse within at least the following four months, whereas high levels are associated with relapse in three out of each four patients.

P107 Usefulness of a rapid test for fecal calprotectin as predictor of relapse in Crohn's disease patients under maintenance treatment with adalimumab

Background: Predicting relapse in Crohn’s disease (CD) patients by measuring non-invasive biomarkers could allow for early changes of treatment. Data are scarce regarding the usefulness of monitoring with calprotectin to predict relapse. The aim of the study was to evaluate the predictive value of a rapid test of fecal calprotectin to predict for flares in CD patients under maintenance treatment with adalimumab (ADA). Methods: A prospective, observationalcohort study was designed. Inclusion criteria were CD patients in clinical remission for at least six months under a continuous standard dose of 40mg/eow ADA therapy. Fresh faecal calprotectin was measured using a rapid test (Quantum blue®) on the day of the first ADA injection. Quantum blue ®is a rapid test for measuring calprotectin in less than half an hour. Clinical examination was performed during the following 4 months. Relapse was defined as a Harvey Bradshaw score >4. Results are shown as mean±SD and compared by the U-Mann Whitney test. ROC analysis was performed and the diagnostic accuracy was calculated. Results: Thirty patients were included (mean age 40 years, 56.7% female). After the four months follow-up, twentyone (70.0%) patients remained in clinical remission and nine (30.0%) have had a relapse. Fecal calprotectin concentration at inclusion was significantly higher in those patients who relapsed during the follow-up (803±514mg/g) than in those who maintained in remission (95±104mg/g) (p < 0.005). The optimal cut-off of fecal calprotectin to predict remission was 204mg/g according to the ROC analysis. The area under the ROC curve was 0.97 (p < 0.005). Sensitivity, specificity, positive and negative predictive value of fecal calprotectin to predict relapse were 100%, 85.7%, 74.1% and 100%, respectively. Levels of calprotectin were correlated with levels of C-reactive protein (r = 0.51, P< 0.005). After multiple linear regression, we observed that if we made adjustments with other relevant sociodemographic and clinical variables, calprotectin and older age were the most important risk factors for the presence of relapse. Conclusions: In CD patients under ADA maintenance therapy, fecal calprotectin levels allow predicting relapse over the following months with a high accuracy. Low fecal calprotectin levels exclude relapse within at least the following four months, whereas high levels are associated with relapse in three out of each four patients.

Role of Fecal Calprotectin in Monitoring Response to Therapy in Inflammatory Bowel Diseases

Inflammatory bowel diseases (IBDs) are chronic intestinal disorders characterized by a typically relapsing course. Disease flares occur in a random way and are often unpredictable. In search to provide noninvasive, cheap and rapid methods able to help in diagnosis and monitoring of IBD activity, within the last years, fecal neutrophil-granular proteins, like calprotectin, have been largely studied. Different studies showed a good diagnostic accuracy of fecal calprotectin (FC) in IBDs and a close correlation between levels of this marker and degree of IBD activity.More recently, emerging interest has rising on the role of FC in assessing response to therapy and predicting relapse in IBD. We performed a MEDLINE search for more recent articles published on this topic. Encouraging results show that FC represents a reliable monitoring tool to assess response to treatment, significantly more accurate than serum markers and clinical parameters. Normalization of FC concentrations (FCCs) results as an accurate indicator of endoscopic healing. FC also appears to have a good diagnostic precision in predicting IBD relapse, possibly more in ulcerative colitis than in Crohn’s disease. However, mainly for this last topic, available evidences, although promising, are still heterogeneous and not sufficiently strong. Assessment of usefulness and predictive value of FC according to different medications, frequency of determinations, the establishment of validated cut-off, should be better evaluated in larger and prospective studies.

PTH-136 Faecal Calprotectin - Is it Requested Appropriately and is it Cost Effective?

IntroductionFaecal calprotectin is a neutrophil derived protein that can be detected by quantitative enzyme linked immunosorbant assay in stool samples. It reliably predicts the level of mucosal inflammation in the...

PTH-078 A Prospective Evaluation of the Predictive Value of Faecal Calprotectin in Quiescent Crohn’S Disease

IntroductionStudies have suggested that faecal calprotectin (FC) levels may increase early in inflammatory bowel disease relapse before the patient is symptomatic and thus may be useful to identify patients at...

Tu1111 A Prospective Evaluation of the Predictive Value of Faecal Calprotectin in Quiescent Crohn's Disease

Introduction Studies have suggested that faecal calprotectin (FC) levels may increase early in inflammatory bowel disease relapse before the patient is symptomatic and thus may be useful to identify patients at a higher risk of relapsing. The purpose of this study was to evaluate the role of FC in predicting relapse in patients followed up for a minimum of 12 months and to ascertain the best cut-off for this in our cohort of adult patients with quiescent Crohn’s disease (CD). Methods Patients with CD in clinical remission were recruited and followed up prospectively for a minimum of 12 months. Participants provided stool for FC concentration analysis and the study was terminated once the last recruited patient reached a follow up period of 365 days. Remission was defined as a Crohn’s disease activity index (CDAI) of Results 98 patients were recruited. One patient was lost to follow up, 1 died and the care of 3 patients was transferred to another centre, before either relapsing or being followed up for 12 months. Of the 93 remaining patients 11 (12%) had relapsed by 12 months. The median FC was lower for non-relapsers, 96 µg/g (IQR 39–237), than for relapsers, 328 µg/g (IQR 189–574), (p = 0.008). The area under the ROC curve to predict relapse using FC was 74.8% (Figure 1). A cut-off FC value of 240 µg/g to predict relapse of quiescent Crohn’s disease over the course of one year was associated with a sensitivity of 72.7% and specificity of 74.3%. Negative predictive value was high at 95.3% and positive predictive value was 27.6%.There was a significant difference in time to relapse for those with the first FC value below or above 240 µg/g (p = 0.011). Conclusion In this prospective dataset, FC appears to be a useful, non-invasive tool to help identify quiescent Crohn’s disease patients at a low risk of relapse over the ensuing 12 months. A FC value of 240 µg/g was deemed the best cut-off value in our patients. Disclosure of Interest None Declared.

P302 A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn's disease

P302 A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn's disease

Faecal Calprotectin as Reliable Non-invasive Marker to Assess the Severity of Mucosal Inflammation in Patients with Ulcerative Colitis

Background and study aim: We aimed to evaluate the validity and accuracy of the faecal calprotectin in differentiating patients with IBD from those with IBS and in the assessment of the severity of intestinal mucosal inflammation in patients with ulcerative colitis (UC) which may facilitate in the prognosis and follow. Patients and Methods: We studied 60 Patients who came to endoscopy unit with lower gastroenterological symptoms. Patients with history of infections, malignancy, gastrointestinal surgery, pregnancy, alcohol abuse or taking nonsteroidal anti-inflammatory drugs were excluded from study. All patients subjected to thorough medical history, simple clinical colitis activity index was determined with a score ˃ 4 indicate active UC, complete blood picture, liver, kidney function tests, ESR, CRP, ANCA were done, a stool sample for FC levels determined by a highly sensitive enzymelinked immunosorbent assay and total colonoscopy with histological examination of intestinal mucosa biopsy were done. The patients divided into 2 groups. Group A: patients with UC, group B: patients with manifestation of irritable bowel syndrome as a control group. Results: There was a high significant difference between individuals with no pathological activity and other degree of mucosal inflammation as regard simple clinical colitis activity index, endoscopic appearance and faecal calprotectin (p = 0.000). The sensitivity, specificity, positive predictive value and negative predictive value of faecal calprotectin in diagnosis of UC were 93.5%, 89.7%, 90.6%, and 92.9% respectively. The positive predictive value and negative predictive value of simple clinical colitis activity index for diagnosis of UC were 76.5% and 80.8% respectively. The positive predictive value and negative predictive value of endoscopic appearance for diagnosis of UC were 100%, and 85.3% respectively. There was a high significant difference and positive correlation between faecal calprotectin, score of colonic pathological activity, endoscopic appearance and simple clinical colitis activity index. Conclusion: Faecal calprotectin is highly useful for the diagnosis and disease monitoring of patients with UC as it is easy, non invasive, reliable tool

Can we improve the negative predictive value of faecal calprotectin for the diagnosis of IBS in primary care?

IntroductionRecent data has established faecal calprotectin (FC) as a highly sensitive and specific test for detecting inflammatory bowel disease (IBD) in patients referred to secondary care.1 Computer modelling has shown...

Faecal calprotectin in children with clinically quiescent inflammatory bowel disease

Objective. The use of faecal calprotectin as a surrogate marker for intestinal inflammation is emerging. However, the data on faecal calprotectin during maintenance therapy in children with inflammatory bowel disease, IBD, are sparse. Our aim was to study faecal calprotectin levels in paediatric IBD during clinically quiescent disease and to investigate if high levels were associated with a flare-up of the disease. Subjects and methods. Faecal calprotectin level was measured in 72 children with paediatric IBD in clinical remission (median age 13 years). Of these, 37 children had been in clinical remission for more than a year, 20 for 6–12 months and 15 for 3 to <6 months. The clinical outcome of the patients was followed up to the first relapse or up to 12 months. Results. When in clinical remission, 35% (25/72) of the children had normal faecal calprotectin (<100 μg/g) and 13% (9/72) a very high level (>1000 μg/g) while not reporting symptoms. A clinical relapse occurred in 35% (25/72) during the subsequent 12 months. When in clinical remission, the predictive value of faecal calprotectin for an overt relapse was low ranging from 0.396 to 0.429 for faecal calprotectin values >100 μg/g or >1000 μg/g, respectively. The negative predictive value was 0.75 for values <100 μg/g. Conclusions. In paediatric IBD, subjective symptoms and clinical assessment associate poorly with the levels of faecal calprotectin. During maintenance medication in colonic disease, the probability of staying in clinical remission for a subsequent year is high if faecal calprotectin value is low.

Fecal Calprotectin as a Predictor of Abnormal Colonic Histology

Gastroenterologists have been seeking reliable noninvasive indices of inflammatory and malignant bowel disease. This prospective study was to assess the value of fecal calprotectin in predicting abnormal histologic findings in patients undergoing colonoscopy. Stool specimens supplied before colonoscopy by 72 consecutive patients were measured for calprotectin levels, and the findings correlated with the colonoscopy results and other fecal and blood parameters. Receiver operating characteristics curve analysis was used to determine the predictive value of fecal calprotectin for abnormal colonic histology. Patients with abnormal histologic findings had significantly higher calprotectin levels (218 +/- 125 mg percent) than patients with normal colonoscopy (77 +/- 100 mg percent). There was a highly significant correlation between calprotectin levels and erythrocyte sedimentation rate (r = 0.45, P = 0.008), positive fecal occult blood test (r = 0.57, P = 0.0001), and abnormal colonic histology (r = 0.54, P = 0.0001). Patients with active inflammatory bowel disease had higher calprotectin levels than the rest of the study patients (r = 0.3; P = 0.01). On multivariate analysis, calprotectin was a significant predictor of abnormal colonic histology (P = 0.005; odds ratio, 1.007; 95 percent confidence interval, 1.002-1.012). The area under the receiver operating characteristics curve was 0.79. A fecal calprotectin concentration of 150 microg/ml had a sensitivity of 75 percent, specificity of 84 percent, positive predictive value of 80 percent, and negative predictive value of 75 percent in predicting abnormal colonic histology. Fecal calprotectin may serve as a simple, noninvasive surrogate marker of abnormal histologic findings in patients scheduled for colonoscopy.