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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    • "As endoscopic mucosal healing recently has become the optimal goal in the treatment of IBD345, the need for validated biomarkers of inflammation that may reduce endoscopies in this patient group is obvious. Numerous publications have evaluated faecal (f-) calprotectin as a reliable biomarker of intestinal inflamma- tion[1,6789, with the ability to identify endoscopic active IBD from inactive with high sensitivity and specificity1011121314. Elevated f-calprotectin is also demonstrated to predict relapse prior to clinical active disease, supporting a strategy of consecutive f-calprotectin analyses for disease monitoring even in remission[1,15,16]. "
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    ABSTRACT: Faecal (f-) calprotectin is a widely used marker for intestinal inflammation. However, extraction procedure is time consuming and cumbersome. The main aim of this study was to evaluate patient-performed extraction of f-calprotectin compared to extraction performed in the laboratory. A total of 81 adult patients with an established diagnosis of inflammatory bowel disease provided two samples from the same bowel movement, one conventional faeces sample and one sample with a patient administered extraction device. A laboratory technician extracted the conventional faeces sample with the same extraction device. F-calprotectin results from the laboratory-performed extraction and the patient-performed extraction correlated significantly, with a Spearman rank correlation coefficient of 0.92. Method comparison showed a slope of 1.20 (95% confidence interval 1.08–1.36) with intercept of –0.30 (95% confidence interval –9.00 to 4.62). This demonstrates a small proportional difference between the results from the home extracted samples and the results from the laboratory extracted samples, where the home extracted samples are slightly higher. However, six of the 81 patients had made obvious mistakes in the extraction process and their samples were excluded from the study. Patient administered extraction of f-calprotectin can be a realistic alternative for selected patients. However, instructions must be very precise to avoid mistakes.
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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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    ABSTRACT: Background and aim: Serum calprotectin is elevated in patients with inflammatory bowel disease (IBD). Whether it correlates other markers of disease activity is unknown. The aim of this study was to correlate serum calprotectin with biochemical and histological measures of intestinal inflammation. Materials and methods: TNBS colitis was induced in wistar rats, and serial blood samples were collected at 0, 3, and 12 days. Animals were subsequently sacrificed for pathological evaluation at day 12. Serum calprotectin and cytokines were measured by ELISA. Pathologic changes were classified at the macroscopic and microscopic levels. Results: TNBS colitis induced elevated serum calprotectin, TNF and IL-6 within 24 h. Levels of serum calprotectin remained elevated in parallel to persistence of loose stool and weight loss to day 12. Serum calprotectin levels correlated with serum levels of TNF-α and IL6 (p < 0.001), but not CRP. Animals with liquid stool had significantly higher levels of serum calprotectin than control animals. There was a correlation between macroscopic colitis scores, and levels of serum calprotectin. Conclusion: Serum calprotectin levels correlate with biochemical and histological markers of inflammation in TNBS colitis. This biomarker may have potential for diagnostic use in patients with IBD.
    Full-text · Article · Apr 2013 · Cellular Immunology
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    ABSTRACT: and Aim . In the inflammatory bowel diseases (IBDs), many symptoms are similar to the functional disorder irritable bowel syndrome (IBS). A challenge is thus to distinguish symptoms of IBD from IBS. The aim of this study was to investigate the levels of calprotectin in IBS-positive IBD patients in remission. Methods . Remission was defined as a simple clinical colitis activity index (SCCAI) or simple crohn’s disease activity index (SCDAI) score of less than three and less than four, respectively. The Rome II criteria were used to identify cases, and the calprotectin ELISA test was used to quantify calprotectin in stools. Results . The Rome II criteria were fulfilled in 24.6% of ulcerative colitis (UC) patients, while the comparable number for Crohn's disease (CD) was 21.4%. There was a tendency for elevated fecal calprotectin levels in IBS-positive patients, regardless of diagnosis. However, these differences were only significant in CD. Conclusions . Calprotectin levels are elevated in subgroups of IBD patients that are in remission and have coexisting IBS-like symptoms. This study underscores the clinical usefulness of a noninvasive marker to distinguish patients in need of intensified followup from those that do not need further workup.
    Full-text · Article · Feb 2013 · Gastroenterology Research and Practice
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