Calprotectin, Biomarker of Depression in Patients with Inflammatory Bowel Disease?

Abstract

Background and Objectives: Calprotectin is a marker for intestinal inflammation. Recent research suggests a link between inflammation and depression. This study assessed the association between the levels of calprotectin in patients from South-Eastern Europe and the severity of depression, anxiety, and quality of life. Materials and Methods: This cross-sectional study included 30 confirmed patients with Crohn’s disease (CD) and ulcerative colitis (UC) who were assessed using clinical interviews for determining the severities of mental disorders (i.e., depression severity—PHQ-9, anxiety—GAD-7) and the quality of life (EQ-5D). Stool samples were collected from all participants for measuring their levels of calprotectin. Results: The level of calprotectin is correlated with PHQ-9 (ρ = 0.416, p = 0.022) and EQ-5D (ρ = −0.304, p = 0.033) but not with GAD 7 (ρ = 0.059, p = 0.379). Calprotectin levels in patients with mild, moderate, and moderately severe depression were significantly higher than in patients with minimal depression (198 µg/g vs. 66,9 µg/g, p = 0.04). Calprotectin level was corelated with the following depressive symptoms: autolytic ideation (ρ = 0.557, p = 0.001), fatigue (ρ = 0.514, p = 0.002), slow movement (ρ = 0.490, p = 0.003), and sleep disorders (ρ = 0.403, p = 0.014). Calprotectin was an independent predictor of depression with an odds ratio of 1.01 (95%: 1.002–1.03, p < 0.01). An ROC analysis showed that a level of calprotectin of 131 µg/g or higher has a sensitivity of 82%, a specificity of 61%, and an accuracy of 70% for predicting depression. In this study, no significant correlations were found between calprotectin level and anxiety. Conclusions: Calprotectin levels are associated with the severity of depression, and checking for a calprotectin level of 131 µg/g or higher may be a potential accessible screening test for depression in patients with inflammatory bowel disease.

Fecal Calprotectin as a Biomarker of Depression Severity: A Systematic Review

“…Asscher et al found no difference in the proportion of abnormal GDS scores between their groups (which they confirmed in a sensitivity analysis using ≥ 50µg/g and <50 µg/g to define high and low FC groups respectively) [18]. Iordache and colleagues offered a novel insight, correlating absolute FC concentration with questionnaire scores in order to determine the ideal threshold for detection of clinical depression [14]. Here, Iordache et al reported that a cut-off of 131 µg/g or higher could potentially be used to predict clinical depression, having a sensitivity of 82%, specificity of 61%, and accuracy of 70% in their sample population [14].…”

“…Out of the studies selected, the scales used to assess depression were the Patient Health Questionnaire (PHQ-9) [14,15,19], the Hamilton Depression Rating Scale (HDRS24/HAM-D) [21,22], the Geriatric Depression Scale (GDS) [18], and the Hospital Anxiety and Depression Scale (HADS-D) [20]. All these scales are validated for assessing depression severity in clinical settings [23][24][25][26].…”

“…Six of the seven included articles investigated the relationship between FC and depression scores through a correlational analysis. Of these, two articles found no significant association between FC concentrations and depression severity [15,20], two found significant moderate positive correlations between FC concentrations and depression severity [14,22], and one found a significant weak positive correlation between the two variables in Crohn's disease (CD) patients but not ulcerative colitis patients (UC) [19]. One study found no correlation between baseline depression scores and FC concentrations but found that the change in depression scores after a six-week escitalopram treatment regimen was correlated with the change in FC concentrations [21].…”

“…Out of the seven papers selected for review, four of them studied patients with inflammatory bowel disease (IBD) [14,15,18,19]. Melchior 2017 [20] studied IBS patients, Liskiewicz 2021 [21] studied hospital in-patients with MDD, and Chojnacki 2022 [22] studied both healthy controls and patients suffering from small intestinal bacterial overgrowth (SIBO).…”

“…In addition to being a specific biomarker for mucosal inflammation [12], FC is also associated with intestinal permeability [13], which as mentioned, may be linked to depression. Iordache and colleagues [14] had recently found that FC concentration has moderate positive correlations with depression severity and can be used diagnostic tool for detecting depression. However, conflicting findings from other studies [15] highlight the need for a comprehensive review of the topic.…”