Combined evaluation of fecal calprotectin and C-reactive protein as a therapeutic target in the management of patients with Crohn's disease

Penna, Francisco Guilherme Cancela e; Rosa, Rodrigo Macedo; Pereira, Fernando Henrique; Cunha, Pedro Ferrari Sales; Sousa, Stella Cristina S.; Ferrari, Teresa C. A.; Cuite, Cara L.; Ferrari, Maria de Lourdes Abreu

doi:10.1016/j.gastrohep.2020.04.015

Cited by 3 publications

(4 citation statements)

References 46 publications

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“…Within the included 25 studies (Table 1), FC sensitivities in discriminating endoscopically active CD ranged from 52 to 97% with a specificity ranging from 45 to 98%. The highest sensitivity was reported by Chen et al (97%), with the highest specificity reported by Lobaton et al (98%) [30,39]. The DOR was 13.93 (95% CI 10.89-17.81) with an i 2 value of 1.34%, suggesting an insignificant heterogeneity and a negative likelihood ratio of 0.27 (95% CI 0.22-0.33) (Figures 3 and 4).…”

Section: Detection Of Endoscopic Activitymentioning

confidence: 82%

The Utility of Faecal Calprotectin, Lactoferrin and Other Faecal Biomarkers in Discriminating Endoscopic Activity in Crohn’s Disease: A Systematic Review and Meta-Analysis

et al. 2023

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Introduction: Currently, faecal calprotectin (FC) is the predominate faecal biomarker utilised in clinical practice to monitor Crohn’s disease (CD) activity. However, there are several potential faecal biomarkers described in the literature. We performed a meta-analysis to determine the accuracy of faecal biomarkers in discriminating endoscopic activity and mucosal healing in CD. Methods: We searched the medical literature using MEDLINE, EMBASE, and PubMed from 1978 to 8 August 2022. Descriptive statistics, including sensitivity, specificity of the primary studies, their positive and negative likelihood ratios, and their diagnostic odds ratio (DOR), were calculated. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS) criteria. Results: The search found 2382 studies, of which 33 were included for analysis after screening. FC was found to have a pooled sensitivity and specificity, DOR, and negative predictive value (NPV) in discriminating active endoscopic disease (versus inactive) of 81%, 74%, 13.93, and 0.27, respectively. Faecal lactoferrin (FL) had a pooled sensitivity and specificity, DOR, and NPV in discriminating active endoscopic disease of 75%, 80%, 13.41, and 0.34, respectively. FC demonstrated a pooled sensitivity and specificity, DOR, and NPV of 88%, 72%, 18.17, and 0.19 in predicting mucosal healing. Conclusion: FC remains an accurate faecal biomarker. Further evaluation of the utility of novel faecal biomarkers is needed.

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Section: Detection Of Endoscopic Activitymentioning

confidence: 82%

The Utility of Faecal Calprotectin, Lactoferrin and Other Faecal Biomarkers in Discriminating Endoscopic Activity in Crohn’s Disease: A Systematic Review and Meta-Analysis

et al. 2023

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“…A previous study verified that FCP is suitable for distinguishing mild endoscopic activity from endoscopic remission, while it is difficult to distinguish partial endoscopic remission from complete endoscopic remission[ 21 ]. Similar to blood trough level, the optimal cut off value of FCP for distinguishing endoscopic activity from endoscopic remission ranges from 71 μg/g to 250 μg/g with moderate diagnostic performance[ 22 - 27 ]. The study identified that FCP > 276 μg/g predicted endoscopic activity at week 54 of CD patients with clinical remission at week 14 moderately with 84.6% sensitivity and 92.1% specificity.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the previous study preferred to utilize CRP to distinguish moderate to severe endoscopic activity from mild to moderate endoscopic activity rather than distinguish mild endoscopic activity from endoscopic remission. A Spanish study showed that FCP > 155 μg/g in combination with CRP > 6.7 mg/L could identify endoscopic activity with 82% specificity[ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Infliximab trough level combined with inflammatory biomarkers predict long-term endoscopic outcomes in Crohn’s disease under infliximab therapy

Cao¹,

Huang²,

Liu³

et al. 2022

WJG

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BACKGROUND Infliximab trough level (ITL) severely affects therapeutic outcomes of Crohn’s disease (CD) patients under infliximab (IFX). Recently, frontier research has focused on identifying ITL based on different therapeutic targets. Although previous studies have elaborated clinical value of ITL monitoring on short-term outcomes in CD patients during therapy, studies contraposing the predictive value of ITL on long-term endoscopic outcomes in CD patients are still scarce domestically and overseas. AIM To explore the predictive value of ITL in combination with inflammatory biomarkers on long-term endoscopic outcomes in CD with clinical remission during IFX maintenance therapy. METHODS CD patients with endoscopic remission under long-term IFX maintenance therapy in the First Affiliated Hospital of Zhejiang Chinese Medicine University from January 2012 to December 2020 were collected. ITL and inflammatory biomarkers were continuously monitored during the therapy. The Step I study was conducted from weeks 14 to 54 of IFX treatment. The Step II study was conducted from weeks 54 to 108 of IFX treatment. Endoscopic outcomes were defined as endoscopic activity (Crohn’s disease endoscopic index of severity score > 2 points or Rutgeerts score > i1) and endoscopic remission (Crohn’s disease endoscopic index of severity score ≤ 2 points or Rutgeerts ≤ i1). Endoscopic relapse free survival was defined as endoscopic remission at the beginning of the study stage and maintaining endoscopic remission during the study stage. RESULTS At week 14, low ITL [odds ratio (OR) = 0.666, 95% confidence interval (CI): 0.514-0.862, P < 0.01] and high fecal calprotectin (FCP) level (OR = 1.002, 95%CI: 1.001-1.004, P < 0.01) increased the risk of endoscopic activity at week 54. At week 54, low ITL (OR = 0.466, 95%CI: 0.247-0.877, P < 0.01) and high C-reactive protein (CRP) level (OR = 1.590, 95%CI: 1.007-2.510, P < 0.01) increased the risk of endoscopic activity at week 108. At week 14, ITL ≤ 5.60 μg/mL [area under the curve (AUC) = 0.83, 95%CI: 0.73-0.90, P < 0.001] and FCP > 238 μg/g (AUC = 0.82, 95%CI: 0.72-0.89, P < 0.001) moderately predicted endoscopic activity at week 54. ITL ≤ 5.60 μg/mL in combination with FCP > 238 μg/g indicated 82.0% possibility of endoscopic activity. At week 54, ITL ≤ 2.10 μg/mL (AUC = 0.85, 95%CI: 0.72-0.93, P < 0.001) and CRP > 3.00 mg/L (AUC = 0.73, 95%CI: 0.60-0.84, P = 0.012) moderately predicted moderate endoscopic activity at week 108. ITL ≤ 2.10 μg/mL in combination with CRP > 3.00 mg/L indicated 100.0% possibility of endoscopic activity. From weeks 14 to 54 of IFX treatment, patients with ITL > 5.60 μg/mL had higher rate of endoscopic relapse free survival than those with ITL ≤ 5.60 μg/mL...

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“…As we all know, CRP is by far the most widely investigated serum index in evaluating disease activity and predicting therapeutic outcomes in clinical practice. Tremendous studies had demonstrated the capacity of CRP elevation for detecting mucosal inflammation [ 34 , 35 ]. In a cross-sectional study, Yarur et al showed that the AUC, sensitivity and specificity of CRP were separately 0.75, 69% and 62% in the evaluation of endoscopic disease activity [ 36 ], which is in consistence with our outcomes.…”

Section: Disscussionmentioning

confidence: 99%

Combined use of CDAI and blood indices for assessing endoscopic activity in ileocolic Crohn’s disease

Hu,

Li,

Sun

et al. 2023

BMC Gastroenterol

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Background Mucosal healing has become the primary treatment target for patients with Crohn’s disease (CD). We aimed to develop a noninvasive and convenient tool to evaluate the endoscopic activity in patients with ileocolic CD. Methods A retrospective multicenter study including 300 CD patients (training, 210 patients; test, 90 patients) was conducted at two tertiary referral centers. Independent risk factors associated with endoscopic activity were explored, which were then combined into a comprehensive index. The predictive performance was evaluated with the area under receiver operating characteristic curve (ROC). Cohen’s Kappa was adopted to examine the consistency between each indicator and endoscopic activity. Results A total of 210 CD patients were recruited in the training cohort. We found that Crohn’s Disease Activity Index (CDAI), C-reactive protein (CRP) and platelet-to-lymphocyte percentage ratio (PLpR) were independently associated with endoscopic activity. Additionally, the comprehensive index generated from the above three indices achieved good discrimination and performed better than CDAI in AUC (0.849 vs. 0.769, P < 0.05). This was further well demonstrated by the external test cohort, which showed good discrimination (AUC: 0.84, 95% CI: 0.744–0.936). Intra-individual comparison revealed the comprehensive index to be superior in the prediction of endoscopic activity. In the subgroup analysis, the AUC of comprehensive index was significantly higher than CDAI especially in inflammatory phenotype (0.824 vs. 0.751, P < 0.05). Conclusion Combining CDAI, CRP and PLpR significantly improved the accuracy for predicting endoscopic activity in ileocolic CD, which can help better monitor an endoscopic flare.

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Combined evaluation of fecal calprotectin and C-reactive protein as a therapeutic target in the management of patients with Crohn's disease

Cited by 3 publications

References 46 publications

The Utility of Faecal Calprotectin, Lactoferrin and Other Faecal Biomarkers in Discriminating Endoscopic Activity in Crohn’s Disease: A Systematic Review and Meta-Analysis

The Utility of Faecal Calprotectin, Lactoferrin and Other Faecal Biomarkers in Discriminating Endoscopic Activity in Crohn’s Disease: A Systematic Review and Meta-Analysis

Infliximab trough level combined with inflammatory biomarkers predict long-term endoscopic outcomes in Crohn’s disease under infliximab therapy

Combined use of CDAI and blood indices for assessing endoscopic activity in ileocolic Crohn’s disease

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