Clinical importance of faecal calprotectin variability in inflammatory bowel disease: intra-individual variability and standardisation of sampling procedure

Kristensen, Vendel; Malmstrøm, Gunn Helen; Skar, Viggo; Røseth, Arne; Moum, Bjørn

doi:10.3109/00365521.2015.1117650

Cited by 40 publications

(24 citation statements)

References 25 publications

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“…Indeed in previous studies, significant variation in FC concentrations has been observed, mainly in subgroups of IBD patients [UC or CD with quiescent or active disease]. 25,[31][32][33] Our results in terms of intra-individual variability of FC are in agreement with other recent studies. 25,31 Calafat et al 31 showed a median CV of 40% in samples collected during the same day, and Lasson et al 25 showed a median CV of 52% and a strong correlation in terms of FC concentrations between two random samples collected during the same day [within-day variation] with an ICC of 0.79.…”

Section: Discussionsupporting

confidence: 93%

“…Regarding this issue, Lasson et al 25 found that FC sampling should be taken from the first bowel movement of the morning, given a significant positive correlation between the level of FC and the time between bowel movements. However, Kristensen et al 33 did not show significant intra-individual diurnal variation, even though this was on a limited number of patients [n = 50]. In the same way, Calafat et al 31 showed that the timing of stool sampling does not seem to be relevant, because the highest or lowest FC values may also vary during the day.…”

Section: Discussionmentioning

confidence: 96%

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Variability of Faecal Calprotectin in Inflammatory Bowel Disease Patients: An Observational Case-control Study

Cremer

Amininejad

et al. 2019

Journal of Crohn's and Colitis

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Background and Aims Several factors have been reported to affect faecal calprotectin [FC] values, and significant variation in FC concentrations has been observed in inflammatory bowel disease [IBD] patients. We aimed to evaluate FC variability in IBD patients, and to assess the robustness of a single stool punch. Methods This is a single-centre observational case-control study. Disease activity was assessed using endoscopic and clinical activity scores, as well as C-reactive protein levels. Stool samples were collected twice within a 1 to 6 days interval, and FC was measured on punches and homogenates by fluorometric enzyme immunocapture assay. Results In all, 260 stool samples were collected from 120 patients. Intrastool variability was low, with an intraclass correlation coefficient for single measures between three punches from a single stool sample of 0.91, and median coefficient of variation [CV] of 17%. CV of two stool samples a few days apart [intra-individual variability] were significantly higher [p <0.01] with median CV of 36%. FC standard deviations correlated with mean FC levels either for intrastool or for intra-individual variability, with a Spearman’s coefficient of rank correlation of 0.85 and 0.78, respectively [p <0.01]. Disease type, location, activity, and FC levels did not influence variability. Conclusions A single stool punch is reliable for FC measurement, considering that intrastool variability is low. Intra-individual variability a few days apart is significantly higher. Therefore, decision-making strategies based on single measurements should consider this variability, to determine the minimum optimal variation to be achieved, rather than a cut-off, especially in high FC levels.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Variability of Faecal Calprotectin in Inflammatory Bowel Disease Patients: An Observational Case-control Study

Cremer

Amininejad

et al. 2019

Journal of Crohn's and Colitis

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“…This variation is even described within the same day in patients with active UC [ 26 , 27 ], which may be confusing in clinical practice. However, we have previously demonstrated that f-calprotectin levels crossed proposed cut-off levels in only a minority of UC patients [ 28 ]. Nevertheless, one single f-calprotectin indicative of endoscopic mucosal healing should be confirmed with a consecutive control.…”

Section: Discussionmentioning

confidence: 99%

Fecal Calprotectin: A Reliable Predictor of Mucosal Healing after Treatment for Active Ulcerative Colitis

Kristensen

Røseth

Ahmad

et al. 2017

Gastroenterology Research and Practice

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Objectives Mucosal healing has become the new goal of treatment in ulcerative colitis. Fecal calprotectin has been demonstrated to differentiate between mucosal inflammation and mucosal healing. With this project, we investigated whether a reduction in f-calprotectin to <250 μg/g after medical treatment for active ulcerative colitis could predict mucosal healing. Material and Methods After a baseline colonoscopy, 20 patients with active ulcerative colitis were followed with consecutive fecal calprotectin monthly until two measurements of fecal calprotectin < 250 μg/g or a maximum follow-up of 12 months. A flexible sigmoidoscopy was then performed and Mayo endoscopic subscore was used to evaluate degree of inflammation. Simple Clinical Colitis Activity Index was used for evaluation of clinical disease activity. Results A total of 16 patients achieved fecal calprotectin < 250 μg/g during follow-up, and all 16 patients had endoscopic mucosal healing (Mayo endoscopic subscore of ≤1) on the second endoscopy. The remaining four patients had persistently high f-calprotectin levels before the second endoscopy with Mayo endoscopic subscore corresponding to endoscopic mucosal healing in three out of four patients. Conclusions Fecal calprotectin <250 μg/g after medical treatment for active ulcerative colitis is a reliable marker of endoscopic mucosal healing.

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“…So, stool samples obtained from the first bowel movement in the morning have been recommended as the best ones for measuring FCAL [110]. In contrast, another study reported no differences in FCAL levels between morning samples and those from different bowel movements on the same day [111]. Furthermore, a low variability was found across three stool samples obtained on consecutive days from patients with quiescent CD, with reliability to identify a case (defined as FCAL above 50 μg/g) being estimated as "moderately good" [112].…”

Section: Current Limitations In Fcal Routine Clinical Usementioning

confidence: 99%

Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations

Laserna-Mendieta

Lucendo

2019

Clinical Chemistry and Laboratory Medicine (CCLM)

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A growing body of evidence has been published about the usefulness of measuring calprotectin in faecal samples (FCAL) in inflammatory bowel disease (IBD) assessment, including diagnosis, monitoring of disease activity and relapse prediction. Several systematic reviews with meta-analyses compiling studies for each particular clinical setting have been carried out in recent years. Most of these were focused on the use of FCAL in IBD diagnosis and showed a relevant role for this marker in selecting patients with gastrointestinal symptoms who would not need a further examination by endoscopy. Although a lesser number of meta-analyses have been performed on the use of FCAL as a surrogate marker of disease activity, a close correlation between FCAL and endoscopic activity of IBD has been shown. With respect to the predictive capacity of FCAL for IBD relapse, a single meta-analysis published indicates that this role is more limited. Furthermore, FCAL thresholds vary considerably depending on the clinical setting and, what is more concerning, among different commercially available assays due to a lack of FCAL concentration interchangeability. Here, we summarise recent publications about the role and limitations of FCAL in IBD, with a special focus on meta-analyses, and give an overview of alternative faecal biomarkers.

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Clinical importance of faecal calprotectin variability in inflammatory bowel disease: intra-individual variability and standardisation of sampling procedure

Cited by 40 publications

References 25 publications

Variability of Faecal Calprotectin in Inflammatory Bowel Disease Patients: An Observational Case-control Study

Variability of Faecal Calprotectin in Inflammatory Bowel Disease Patients: An Observational Case-control Study

Fecal Calprotectin: A Reliable Predictor of Mucosal Healing after Treatment for Active Ulcerative Colitis

Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations

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