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Carlsen K, Riis LB, Elsberg H, Maagaard L, Thorkilgaard T, Sørbye SW, Jakobsen C, Wewer V, Florholmen J, Goll R, Munkholm P. The sensitivity of fecal calprotectin in predicting deep remission in ulcerative colitis. Scand J Gastroenterol 2018; 53:825-830. [PMID: 29968483 DOI: 10.1080/00365521.2018.1482956] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mucosal healing is proposed as treat-to-target in ulcerative colitis (UC), even though the definition of mucosal healing remains contested as it has been suggested to be assessed by either endoscopy, histology or both. However, all definitions require an endoscopic evaluation of the mucosa. As endoscopies are invasive and uncomfortable to the patient we aimed to calibrate noninvasive predictors of mucosal inflammatory status defined by both endoscopy and histology. METHODS UC patients (n = 106) undergoing a sigmoid-/colonoscopy were prospectively included. Feces (fecal calprotectin, FC), blood samples (hemoglobin, C-reactive protein, orosomucoid, erythrocyte sedimentation rate, albumin) and symptom scores (Simple Clinical Colitis Activity Index, SSCAI) were collected and analyzed. The colonic mucosa was assessed by the Mayo endoscopic sub score and biopsies were obtained for a histologic grading by Geboes score. Predictive cutoff values were analyzed by receiver operating characteristics (ROC). A combined endoscopic and histologic assessment defined deep remission (Mayo =0 and Geboes ≤1) and activity (Mayo ≥2 and Geboes >3). RESULTS Only FC showed a significant ROC curve (p < .05). We suggest FC (mg/kg) cutoffs for detection of following: Deep remission: FC ≤25; Indeterminate: FC 25-230 - an endoscopy is recommended if a comprehensive status of both endoscopic and histologic assessed activity is needed; Active disease: FC >230. The complete ROC data is presented, enabling extraction of an FC cutoff value's sensitivity and specificity. CONCLUSIONS FC predicts endoscopic and histologic assessed deep remission and inflammatory activity of colon mucosa. Neither the markers in blood nor the SCCAI performed significant ROC results.
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Affiliation(s)
- Katrine Carlsen
- a Department of Pathology, Herlev and Gentofte Hospital , University of Copenhagen , Herlev , Denmark.,b Department of Pediatrics , Hvidovre University Hospital , Hvidovre , Denmark
| | - Lene Buhl Riis
- a Department of Pathology, Herlev and Gentofte Hospital , University of Copenhagen , Herlev , Denmark
| | - Henriette Elsberg
- c Department of Gastroenterology, Herlev and Gentofte Hospital , University of Copenhagen , Herlev , Denmark
| | - Louise Maagaard
- c Department of Gastroenterology, Herlev and Gentofte Hospital , University of Copenhagen , Herlev , Denmark
| | - Tine Thorkilgaard
- c Department of Gastroenterology, Herlev and Gentofte Hospital , University of Copenhagen , Herlev , Denmark
| | | | - Christian Jakobsen
- b Department of Pediatrics , Hvidovre University Hospital , Hvidovre , Denmark
| | - Vibeke Wewer
- b Department of Pediatrics , Hvidovre University Hospital , Hvidovre , Denmark
| | - Jon Florholmen
- e Department of Gastroenterology , University Hospital of North Norway , Tromsø , Norway.,f Research Group Gastroenterology and Nutrition, Institute Clinical Medicine , UiT the Arctic University of Norway , Tromsø , Norway
| | - Rasmus Goll
- e Department of Gastroenterology , University Hospital of North Norway , Tromsø , Norway.,f Research Group Gastroenterology and Nutrition, Institute Clinical Medicine , UiT the Arctic University of Norway , Tromsø , Norway
| | - Pia Munkholm
- g Department of Gastroenterology , North Zealand Hospital, University of Copenhagen , Frederikssund , Denmark
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