Fecal Calprotectin More Accurately Reflects Endoscopic Activity of Ulcerative Colitis than the Lichtiger Index, C-reactive Protein, Platelets, Hemoglobin, and Blood Leukocytes

1Department of Gastroenterology and Hepatology, University Hospital Lausanne/CHUV, Switzerland 2Department of Gastroenterology and Hepatology, University Hospital Basel, Switzerland 3Institute of Social and Preventive Medicine, University of Bern, Switzerland 4Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA 5Division of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA 6GI Outcomes Unit, Mayo Clinic, Rochester, Minnesota, USA 7Department of Gastroenterology and Hepatology, McMaster University Hospital, Hamilton, ON, Canada 8Department of Gastroenterology and Hepatology, University Hospital Jena, Germany 9Bioanalytica Medical Laboratories, Lucerne, Switzerland 10Institute of Social and Preventive Medicine, University of Lausanne, Switzerland 11Department of Gastroenterology and Hepatology, University Hospital Zurich, Switzerland.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 01/2013; 19(2). DOI: 10.1097/MIB.0b013e3182810066
Source: PubMed


The correlation between noninvasive markers with endoscopic activity according to the modified Baron Index in patients with ulcerative colitis (UC) is unknown. We aimed to evaluate the correlation between endoscopic activity and fecal calprotectin (FC), C-reactive protein (CRP), hemoglobin, platelets, blood leukocytes, and the Lichtiger Index (clinical score).

UC patients undergoing complete colonoscopy were prospectively enrolled and scored clinically and endoscopically. Samples from feces and blood were analyzed in UC patients and controls.

We enrolled 228 UC patients and 52 healthy controls. Endoscopic disease activity correlated best with FC (Spearman's rank correlation coefficient r = 0.821), followed by the Lichtiger Index (r = 0.682), CRP (r = 0.556), platelets (r = 0.488), blood leukocytes (r = 0.401), and hemoglobin (r = -0.388). FC was the only marker that could discriminate between different grades of endoscopic activity (grade 0, 16 [10-30] μg/g; grade 1, 35 [25-48] μg/g; grade 2, 102 [44-159] μg/g; grade 3, 235 [176-319] μg/g; grade 4, 611 [406-868] μg/g; P < 0.001 for discriminating the different grades). FC with a cutoff of 57 μg/g had a sensitivity of 91% and a specificity of 90% to detect endoscopically active disease (modified Baron Index ≥ 2).

FC correlated better with endoscopic disease activity than clinical activity, CRP, platelets, hemoglobin, and blood leukocytes. The strong correlation with endoscopic disease activity suggests that FC represents a useful biomarker for noninvasive monitoring of disease activity in UC patients.

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    • "However, no correlation was found when comparing the serum calprotectin and C-reactive protein levels in our studies (Fig. 3). These findings confirm what other groups have found with respect to CRP and inflammation in patients with ulcerative colitis [32]. This may have been due to the fact that the C-reactive protein levels peak at the beginning of the disease process and then decrease rapidly. "
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