The Relation Between Fecal Calprotectin and the Rate of Clinical Activity of Ulcerative Colitis

Abstract Background Granulocyte and monocyte adsorptive apheresis (GMA) is widely used as a remission induction therapy for active ulcerative colitis (UC) patients. However, there are no available biomarkers for predicting the clinical outcome of GMA. We investigated the utility of Fecal calprotectin (FC) as a biomarker for predicting the clinical outcome during GMA therapy in active UC patients. Methods In this multicenter prospective observation study, all patients received 10 sessions of GMA, twice a week, for 5 consecutive weeks. FC was measured at entry, one week, two weeks, and at the end of GMA. Colonoscopy was performed at entry and after GMA. The clinical activity was assessed based on the partial Mayo score when FC was measured. Clinical remission (CR) was defined as a partial Mayo score of ≤ 2 and endoscopic remission (ER) was defined as Mayo endoscopic subscore of either 0 or 1. We analyzed the relationships between the clinical outcome (CR and ER) and the change in FC concentration. Result Twenty-six patients were included in this study. The overall CR and ER rates were 50.0% and 19.2%, respectively. After GMA, the median FC concentration in patients with ER was significantly lower than that in patients without ER (469 mg/kg vs. 3107 mg/kg, p = 0.03). When the cut-off value of FC concentration was set at 1150 mg/kg for assessing ER after GMA, the sensitivity and specificity were 0.8 and 0.81, respectively. The FC concentration had significantly decreased by one week. An ROC analysis demonstrated that the reduction rate of FC (ΔFC) at 1 week was the most accurate predictor of CR at the end of GMA (AUC = 0.852, P = 0.002). When the cut-off value of ΔFC was set at ≤ 40% at 1 week for predicting CR at the end of GMA, the sensitivity and specificity were 76.9% and 84.6%, respectively. Conclusion We evaluated the utility of FC as a biomarker for assessing ER after GMA and predicting CR in the early phase during GMA in patients with active UC. Our findings will benefit patients with active UC by allowing them to avoid unnecessary invasive procedures and will help establish new strategies for GMA.

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CLINICAL FORMS OF ULCERATIVE COLITIS AND THEIR FEATURES IN CHILDREN

Science Review ◽

10.31435/rsglobal_sr/31102020/7221 ◽

2020 ◽

Author(s):

Денисова М. Ф. ◽

Букулова Н. Ю.

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Process ◽

Clinical Laboratory ◽

Fecal Calprotectin ◽

Clinical Activity ◽

Clinical Forms ◽

Γ Globulins ◽

Endoscopic Characteristics ◽

And Gender ◽

The Relationship

This article presents frequency of occurrence of clinical forms of the disease depending on the localization and activity of the inflammatory process, their age and gender differences, risk factors and disease triggers, based on a retrospective analysis of 116 cases of children with ulcerative colitis at the age of 4-18 years. Comparative clinical, laboratory and endoscopic characteristics of total, segmental and distal colitis have been also analyzed. It was found that clinical activity of total colitis is characterized by more severe course of the disease, accompanied with systemic and local extraintestinal manifestations (OR = 4,504±0,506, p<0.05), more pronounced changes in hemo- and proteinogram parameters (p<0.05). Endoscopic criteria for differences in the clinical forms of ulcerative colitis are the presence of ulcers (OR = 9,667±0,645, p <0,05), erosions (OR = 3,569±0,429, p<0,05), contact bleeding (OR = 4,364± ,444, p< 0.05), changes in the vascular pattern (OR = 3,748±0,477, p<0.05). Correlation analysis of the relationship between clinical (PUCAI), endoscopic (Rachmilewitz index) and laboratory markers of the inflammatory process (leukocytes, platelets, erythrocyte sedimentation rate, γ-globulins, fecal calprotectin, hemoglobin) has been also performed, the criteria of which might be used to monitor the course of the disease and the effectiveness of therapy.

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Fecal Calprotectin and Clinical Disease Activity in Pediatric Ulcerative Colitis

ISRN Gastroenterology ◽

10.1155/2013/179024 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 15

Author(s):

Kaija-Leena Kolho ◽

Dan Turner

Keyword(s):

Ulcerative Colitis ◽

Clinical Outcome ◽

Roc Curve ◽

Clinical Remission ◽

Activity Index ◽

Fecal Calprotectin ◽

Elisa Test ◽

Clinical Activity ◽

High Level ◽

Active Disease

Objective. To explore fecal calprotectin levels in pediatric ulcerative colitis (UC) in relation with the validated clinical activity index PUCAI. Methods. This study included all 37 children (median age 14 years) with UC who had calprotectin measured (PhiCal ELISA Test) by the time of PUCAI assessment at the Children's Hospital of Helsinki in a total of 62 visits. Calprotectin values <100 μg/g of stool were considered as normal. The best cut-off value of each measure to predict 3-month clinical outcome was derived by maximizing sensitivity and specificity. Results. In clinically active disease (PUCAI ≥ 10), calprotectin was elevated in 29/32 patients (91% sensitivity). When in clinical remission, 26% (8/30) of the children had normal calprotectin but 7 (23%) had an exceedingly high level (>1000 μg/g). The best cut-off value for calprotectin for predicting poor outcome was 800 μg/g (sensitivity 73%, specificity 72%; area under the ROC curve being 0.71 (95%CI 0.57–0.85)) and for the PUCAI best cut-off values >10 (sensitivity 62%, specificity 64%; area under the ROC curve 0.714 (95%CI 0.58–0.85)). Conclusion. The clinical relevance of somewhat elevated calprotectin during clinical remission in pediatric UC is not known and, until further evidence accumulates, does not indicate therapy escalation.

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Clinical Value of Fecal Calprotectin in Predicting Mucosal Healing in Patients With Ulcerative Colitis

Frontiers in Medicine ◽

10.3389/fmed.2021.679264 ◽

2021 ◽

Vol 8 ◽

Author(s):

Fang Chen ◽

Yue Hu ◽

Yi-Hong Fan ◽

Bin Lv

Keyword(s):

Ulcerative Colitis ◽

Predictive Value ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Clinical Activity ◽

Receiver Operator Characteristic ◽

Characteristic Analysis ◽

Active Disease

Aim: This study aimed to evaluate the clinical significance of fecal calprotectin (FC) in assessment of ulcerative colitis (UC) patients' endoscopic patterns and clinical manifestation.Methods: A total of 143 UC patients who received colonoscopy and 108 controls were included. After providing stool samples, patients underwent total colonoscopy. FC was measured by an enzyme-linked immunosorbent assay (ELISA). Clinical activity was based on the Mayo score. Endoscopic findings was scored by the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Correlation analysis and receiver-operator characteristic (ROC) analysis were carried out to determine the significance of measurements.Results: The median (interquartile range, IQR) of FC levels was 211 (43–990) μg/g in UC and 87.5 (40.50~181) μg/g in the control group. Fecal calprotectin correlated significantly with both Mayo and UCEIS scores (Spearman's r 0.670 and 0.592, P < 0.01). With a cut-off value of 164 μg/g for fecal calprotectin concentration, the area under the curve (AUC) in receiver operator characteristic analysis was 0.830, sensitivity was 85.42%, specificity was 73.68%, positive predictive value (PPV) was 62.12%, and negative predictive value (NPV) was 9.10% in predicting clinical active disease. Similarly, the power of FC to predict mucosal healing (MH) was modest. With a cut-off value of 154.5 μg/g, the AUC was 0.839, sensitivity was 72.34%, and specificity was 85.71%.Conclusion: For evaluating the disease activity of UC, FC is a clinically relevant biomarker for both clinically active disease and MH in patients with UC. But the cut-off value still needs large and multicenter studies for confirmation.

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Therapeutic Efficacy of pH-Dependent Release Formulation of Mesalazine on Active Ulcerative Colitis Resistant to Time-Dependent Release Formulation: Analysis of Fecal Calprotectin Concentration

BioMed Research International ◽

10.1155/2014/342751 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Kousaku Kawashima ◽

Shunji Ishihara ◽

Takafumi Yuki ◽

Koji Onishi ◽

Yoshinori Kushiyama ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Efficacy ◽

Activity Index ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Time Dependent ◽

Clinical Activity ◽

Active Ulcerative Colitis ◽

Release Formulation ◽

Ph Dependent

Purpose. Few reports have compared the clinical efficacy of a pH-dependent release formulation of mesalazine (pH-5-ASA) with a time-dependent release formulation (time-5-ASA). We examined whether pH-5-ASA is effective for active ulcerative colitis (UC) in patients resistant to time-5-ASA.Methods. We retrospectively and prospectively analyzed the efficacy of pH-5-ASA in mildly to moderately active UC patients in whom time-5-ASA did not successfully induce or maintain remission. The clinical efficacy of pH-5-ASA was assessed by clinical activity index (CAI) before and after switching from time-5-ASA. In addition, the efficacy of pH-5-ASA on mucosal healing (MH) was evaluated in a prospective manner by measuring fecal calprotectin concentration.Results. Thirty patients were analyzed in a retrospective manner. CAI was significantly reduced at both 4 and 8 weeks after switching to pH-5-ASA. In the prospective study (n=14), administration of pH-5-ASA also significantly reduced CAI scores at 4 and 8 weeks in these patients who were resistant to time-5-ASA. In addition, fecal calprotectin concentration was significantly decreased along with improvement in CAI after switching to pH-5-ASA.Conclusions. Our results suggest that pH-5-ASA has clinical efficacy for mildly to moderately active patients with UC in whom time-5-ASA did not successfully induce or maintain remission.

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Fecal Calprotectin and the Clinical Activity Index Are Both Useful to Monitor Medical Treatment in Patients with Ulcerative Colitis

Digestive Diseases and Sciences ◽

10.1007/s10620-014-3383-0 ◽

2014 ◽

Vol 60 (2) ◽

pp. 485-491 ◽

Cited By ~ 16

Author(s):

Emanuel Burri ◽

Christoph Beglinger ◽

Stefanie von Felten ◽

Frank Serge Lehmann

Keyword(s):

Ulcerative Colitis ◽

Medical Treatment ◽

Activity Index ◽

Fecal Calprotectin ◽

Clinical Activity

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Fecal Calprotectin is a Useful Biomarker for Predicting the Clinical Outcome of Granulocyte and Monocyte Adsorptive Apheresis in Ulcerative Colitis Patients: A Prospective Observation Study.

10.21203/rs.3.rs-154609/v1 ◽

2021 ◽

Author(s):

Nobuhiro Ueno ◽

Yuya Sugiyama ◽

Yu Kobayashi ◽

Yuki Murakami ◽

Takuya Iwama ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Outcome ◽

Sensitivity And Specificity ◽

Reduction Rate ◽

Fecal Calprotectin ◽

Remission Induction ◽

Clinical Activity ◽

Observation Study ◽

Mayo Score ◽

Adsorptive Apheresis

Abstract Background: Granulocyte and monocyte adsorptive apheresis (GMA) is widely used as a remission induction therapy for active ulcerative colitis (UC) patients. However, there are no available biomarkers for predicting the clinical outcome of GMA. We investigated the utility of Fecal calprotectin (FC) as a biomarker for predicting the clinical outcome during GMA therapy in active UC patients.Methods: In this multicenter prospective observation study, all patients received 10 sessions of GMA, twice a week, for 5 consecutive weeks. FC was measured at entry, one week, two weeks, and at the end of GMA. Colonoscopy was performed at entry and after GMA. The clinical activity was assessed based on the partial Mayo score when FC was measured. Clinical remission (CR) was defined as a partial Mayo score of ≤2 and endoscopic remission (ER) was defined as Mayo endoscopic subscore of either 0 or 1. We analyzed the relationships between the clinical outcome (CR and ER) and the change in FC concentration.Result: Twenty-six patients were included in this study. The overall CR and ER rates were 50.0% and 19.2%, respectively. After GMA, the median FC concentration in patients with ER was significantly lower than that in patients without ER (469 mg/kg vs. 3107 mg/kg, p=0.03). When the cut-off value of FC concentration was set at 1150 mg/kg for assessing ER after GMA, the sensitivity and specificity were 0.8 and 0.81, respectively. The FC concentration had significantly decreased by one week. An ROC analysis demonstrated that the reduction rate of FC (ΔFC) at 1 week was the most accurate predictor of CR at the end of GMA (AUC=0.852, P=0.002). When the cut-off value of ΔFC was set at ≤40% at 1 week for predicting CR at the end of GMA, the sensitivity and specificity were 76.9% and 84.6%, respectively.Conclusion: We evaluated the utility of FC as a biomarker for assessing ER after GMA and predicting CR in the early phase during GMA in patients with active UC. Our findings will benefit patients with active UC by allowing them to avoid unnecessary invasive procedures and will help establish new strategies for GMA.

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