AIM To evaluate the utility of fecal calprotectin(FC)in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease(IBD)cohort.METHODS All FC measurements that were obtained during a 3...AIM To evaluate the utility of fecal calprotectin(FC)in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease(IBD)cohort.METHODS All FC measurements that were obtained during a 3-year period from patients with inflammatory bowel disease in clinical remission were identified.Data regarding the short-term(6 mo)course of the disease were extracted from the medical files.Exclusion criteria were defined as:(1)An established flare of the disease at the time of FC measurement,(2)Loss to follow up within 6 mo from baseline FC measurement,and,(3)Insufficient data on file.Statistical analysis was performed to evaluate whether baseline FC measurement could predict the short term clinical relapse and/or the presence of mucosal healing.RESULTS We included 149[Crohn's disease(CD)=113,Ulcerative colitis(UC)=36,male=77]IBD patients in our study.Within the determined 6-month period post-FC measurement,47(31.5%)had a disease flare.Among 76 patients who underwent endoscopy,39(51.3%)had mucosal healing.Baseline FC concentrations were significantly higher in those who had clinical relapse compared to those who remained in remission during follow up(481.0μg/g,286.0-600.0 vs 89.0,36.0-180.8,P<0.001).The significant predictive value of baseline median with IQR FC for clinical relapse was confirmed by multivariate Cox analysis[HR for 100μg/g:1.75(95%CI:1.28-2.39),P=0.001].Furthermore,lower FC baseline values significantly correlated to the presence of mucosal healing in endoscopy(69.0μg/g,30.0-128.0 vs 481.0,278.0-600.0,in those with mucosal inflammation,median with IQR,P<0.001).We were able to extract cut-off values for FC concentration with a high sensitivity and specificity for predicting clinical relapse(261μg/g with AUC=0.901,sensitivity 87.2%,specificity 85.3%,P<0.001)or mucosal healing(174μg/g with AUC=0.956,sensitivity 91.9%,specificity 87.2%,P<0.001).FC was better than CRP in predicting either outcome;nevertheless,having a pathological CRP(>5 mg/L)in addition to the cutoffs for FC,significantly enhanced the specificity for predicting clinical relapse(95.1%from 85.3%)or endoscopic activity(100%from 87.2%).CONCLUSION Serial FC measurements may be useful in monitoring IBD patients in remission,as FC appears to be a reliable predictor of short-term relapse and endoscopic activity.展开更多
文摘AIM To evaluate the utility of fecal calprotectin(FC)in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease(IBD)cohort.METHODS All FC measurements that were obtained during a 3-year period from patients with inflammatory bowel disease in clinical remission were identified.Data regarding the short-term(6 mo)course of the disease were extracted from the medical files.Exclusion criteria were defined as:(1)An established flare of the disease at the time of FC measurement,(2)Loss to follow up within 6 mo from baseline FC measurement,and,(3)Insufficient data on file.Statistical analysis was performed to evaluate whether baseline FC measurement could predict the short term clinical relapse and/or the presence of mucosal healing.RESULTS We included 149[Crohn's disease(CD)=113,Ulcerative colitis(UC)=36,male=77]IBD patients in our study.Within the determined 6-month period post-FC measurement,47(31.5%)had a disease flare.Among 76 patients who underwent endoscopy,39(51.3%)had mucosal healing.Baseline FC concentrations were significantly higher in those who had clinical relapse compared to those who remained in remission during follow up(481.0μg/g,286.0-600.0 vs 89.0,36.0-180.8,P<0.001).The significant predictive value of baseline median with IQR FC for clinical relapse was confirmed by multivariate Cox analysis[HR for 100μg/g:1.75(95%CI:1.28-2.39),P=0.001].Furthermore,lower FC baseline values significantly correlated to the presence of mucosal healing in endoscopy(69.0μg/g,30.0-128.0 vs 481.0,278.0-600.0,in those with mucosal inflammation,median with IQR,P<0.001).We were able to extract cut-off values for FC concentration with a high sensitivity and specificity for predicting clinical relapse(261μg/g with AUC=0.901,sensitivity 87.2%,specificity 85.3%,P<0.001)or mucosal healing(174μg/g with AUC=0.956,sensitivity 91.9%,specificity 87.2%,P<0.001).FC was better than CRP in predicting either outcome;nevertheless,having a pathological CRP(>5 mg/L)in addition to the cutoffs for FC,significantly enhanced the specificity for predicting clinical relapse(95.1%from 85.3%)or endoscopic activity(100%from 87.2%).CONCLUSION Serial FC measurements may be useful in monitoring IBD patients in remission,as FC appears to be a reliable predictor of short-term relapse and endoscopic activity.
