Level of Fecal Calprotectin Correlates With Endoscopic and Histologic Inflammation and Identifies Patients with Mucosal Healing of Ulcerative Colitis

Klaus Theede, Susanne Holck, Per Ibsen, Steen Ladelund, Inge Nordgaard-Lassen, Anette Mertz Nielsen

124 Citationer (Scopus)

Abstract

BACKGROUND & AIMS: In patients with ulcerative colitis (UC), mucosal healing is an important goal of treatment. However, mucosal healing is difficult to determine based on clinical evaluation alone, and endoscopy is uncomfortable and can cause complications. Fecal calprotectin (FC) is a marker of inflammation and its levels have been associated with disease activity. We investigated the association between level of FC and mucosal healing and clinical disease activity in patients with UC.

METHODS: We performed an observational cross-sectional study of 120 patients with active or inactive UC who underwent sigmoidoscopy at Copenhagen University Hospital Hvidovre from September 2012 through 2014. Endoscopic inflammation was evaluated using the Mayo Endoscopic Score (MES) and UC Endoscopic Index of Severity (UCEIS), and histologic inflammatory activity by a slightly modified Harpaz Index, which measures acute inflammation. The Partial Mayo Score was used to measure the clinical disease activity.

RESULTS: A cut-off level of FC of 192 mg/kg identified patients with endoscopic evidence of mucosal healing, based on the MES and UCEIS, with positive predictive values (PPVs) of 0.71 and 0.65, respectively; negative predictive values (NPVs) were 0.90 and 0.93, respectively. A cut-off level of 171 mg/kg identified patients with histologic evidence for mucosal healing with a PPV of 0.75 and an NPV of 0.90. Levels of FC increased significantly with increases in endoscopic and histologic disease activity. There was high concordance between MES and UCEIS, as well between MES or UCEIS and histologic inflammatory activity. The histologic activity index had an inter-observer variation of 4.35%.

CONCLUSIONS: Level of FC identifies patients with UC who have endoscopic and histologic features of mucosal healing, and correlates with endoscopic and histologic inflammatory activity. The UCEIS seems to be as accurate as the MES in identifying patients with mucosal healing, and as easy to use. The histologic activity index had a high concordance with recognized endoscopic score systems.

OriginalsprogEngelsk
TidsskriftClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Vol/bind13
Udgave nummer11
Sider (fra-til)1929-1936 e1
ISSN1542-3565
DOI
StatusUdgivet - nov. 2015

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