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Medbrief
Fecal Calprotectin Predicts Disease Extent, Healing in Ulcerative Colitis
TOPLINE:
Fecal calprotectin (FC) levels were significantly associated with disease activity and extent in ulcerative colitis and also predicted mucosal healing.
METHODOLOGY:
- Researchers conducted a single-center prospective observational study to explore the association between FC levels and mucosal inflammatory activity as well as disease extent in patients with ulcerative colitis.
- Colonoscopy was performed at follow-up visits conducted 3, 11, and 60 months after diagnosis or changing from conventional to advanced treatment.
- Endoscopic disease activity and histologic inflammation were assessed using the Mayo Endoscopic Score (MES) and Nancy Histological Index (NHI), respectively. Active disease was defined as MES ≥ 2, histologic disease activity as NHI ≥ 2, and mucosal healing as MES ≤ 1 and NHI ≤ 1.
- Endoscopic disease extent was categorized using the Montreal classification.
- FC levels were measured from the first morning defecation collected 4 weeks before until 3 days after the study visit.
- The diagnostic accuracy of FC as a marker of mucosal healing was assessed by area under the receiver operating curve.
TAKEAWAY:
- Researchers analyzed data from 518 visits by 254 patients (mean age, 38 years; 56.7% women), in whom disease extent was determined as ulcerative proctitis in 162 cases, left-sided ulcerative colitis in 172 cases, and extensive ulcerative colitis or pancolitis in 184 cases.
- FC levels were significantly higher with increasing disease extent, from a median of 106 mg/kg in ulcerative proctitis to 252 mg/kg in left-sided ulcerative colitis and 663 mg/kg in pancolitis, with the association remaining significant both with and without endoscopically active disease.
- Patients with histologically active disease in all three colorectal segments had significantly higher FC levels than those with active disease in one or two segments.
- The diagnostic accuracy of FC as a marker of mucosal healing was 0.904, with FC levels a reliable marker for this outcome across all disease extent categories.
- The probability of active disease (MES ≥ 2) increased steadily with FC levels, while the probability of extensive disease and MES ≥ 2 increased exponentially at FC levels above 1000 mg/kg.
IN PRACTICE:
“FC measurements can be reliably used in clinical practice to monitor [ulcerative colitis] patients with proctitis,” the authors wrote, adding that the findings “suggest that FC may serve as a valuable marker for severe extensive colitis, warranting further validation in cohorts with suspected [inflammatory bowel disease].”
SOURCE:
This study, led by Øyvind Steinsbø, MD, PhD, Stavanger University Hospital, Stavanger, Norway, was published online in The American Journal of Gastroenterology.
LIMITATIONS:
Central reading was not used for the classification of endoscopic severity by the endoscopist. The segment with the most severe endoscopic findings was used to determine the MES.
DISCLOSURES:
This study was supported by unrestricted grants from AbbVie and Tillotts Pharma. One author reported serving as a speaker and an advisory board member for various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
