Optimal cut‐off value of fecal calprotectin for the evaluation of ulcerative colitis: An unsolved issue?

Abstract

IntroductionThere is variability in the fecal calprotectin (FCP) cut‐off level for the prediction of ulcerative colitis (UC) disease activity and differentiation from irritable bowel disease (IBS‐D). The FCP cut‐off levels vary from country to country.AimsWe aimed to assess FCP as a marker of disease activity in patients with UC. We determined the optimal FCP cut‐off value for differentiating UC and IBS‐D.MethodsIn a prospective study, we enrolled 76 UC and 30 IBS‐D patients. We studied the correlation of FCP with disease activity/extent as well as its role in differentiating UC from IBS‐D. We also reviewed literature regarding the optimal FCP cut‐off level for the prediction of disease activity and differentiation from IBS‐D patients.ResultsSensitivity, specificity, positive predictive value, and negative predictive value of FCP (cut‐off level, 158 μg/g) for the prediction of complete mucosal healing (using Mayo endoscopic subscore) were 90, 85, 94.7, and 73.3%, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of FCP (cut‐off level, 425 μg/g) for the prediction of inactive disease (Mayo Score ≤ 2) were 94.3, 88.7, 86.2, and 95.4%, respectively. We also found a FCP cut‐off value of 188 μg/g for the differentiation of UC from IBS‐D.ConclusionsThe study reveals the large quantitative differences in FCP cut‐off levels in different study populations. This study demonstrates a wide variation in FCP cut‐off levels in the initial diagnosis of UC as well as in follow‐up post‐treatment. Therefore, this test requires validation of the available test kits and finding of appropriate cut‐off levels for different study populations.

Calprotectin in inflammatory bowel disease

“…In another study conducted on 76 patients with ulcerative colitis, a sensitivity of 98% and a specificity of 96% at cutoff of 188 μg/g have been reported in this regard [49] ,. In one study, it was shown that fecal calprotectin in cutoff of 127 μg/g is able to distinguish patients with IBD from patients without IBD (patients with diseases other than IBD, patients with IBS, and healthy persons) with 73% sensitivity and 89% specificity [50] ,.…”

Biochemical Biomarkers of Mucosal Healing for Inflammatory Bowel Disease in Adults

“…The performance of other markers (hemoglobin, CRP, orosomucoid, erythrocyte sedimentation rate, albumins) or the Simple Clinical Colitis Activity Index (SCCAI) as predictors of deep remission and inflammatory activity was not accurate. Jha et al proposed 158 mg/kg for the cut-off value of FC when the definition of mucosal healing was MES ≤ 1 [ 43 ]. Moreover, in a recently published study, Walsh et al showed that FC correlated strongly with UC activity in terms of the endoscopic (UCEIS), histologic (Nancy score), and combined evaluations.…”

Faecal Inflammatory Biomarkers and Gastrointestinal Symptoms after Bariatric Surgery: A Longitudinal Study

“…Values of >200 μg/g are also used in daily practice, as a cutoff for additional diagnostics like endoscopy. In IBD, a system of multiple cutoff values has been proposed to differentiate between disease (in) activity (>425 μg/g), mucosal healing (<158 μg/g), and discriminate between IBS and IBD (<188 μg/g) [39]. It seems to be necessary to determine specific RYGB reference values for fCP and lactoferrin if the postoperative elevation is not due to inflammation but, for example, due to altered clearance of the protein.…”