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Fecal calprotectin levels in healthy children studied with an improved assay
Ulrika Lorentzon Fagerberg1, Lars Lööf, Rumjana Djilali Merzoug
1Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden. ulrika.fagerberg@ks.se
Insights
Fecal calprotectin reference values were established for healthy children aged 4-17 years. The adult cutoff of <50 microg/g is suitable for pediatric use, with higher values indicating potential gastrointestinal inflammation.
Area of Science:
- Pediatric Gastroenterology
- Clinical Chemistry
- Biomarker Research
Background:
- Fecal calprotectin, a neutrophil protein, serves as a key indicator of gastrointestinal inflammation.
- Recent advancements in assay technology necessitate the establishment of updated reference values.
- Understanding pediatric fecal calprotectin levels is crucial for accurate diagnosis.
Purpose of the Study:
- To determine reference values for fecal calprotectin in healthy children aged 4 to 17 years.
- To assess the applicability of the adult cutoff level (<50 microg/g) in pediatric populations.
- To evaluate the clinical significance of elevated fecal calprotectin in children.
Main Methods:
- Fecal samples were collected from 117 healthy children across four age groups (4-6, 7-10, 11-14, 15-17 years).
- Exclusion criteria included intercurrent disease, bleeding, and NSAID use.
- Calprotectin was quantified using a validated enzyme-linked immunosorbent assay (ELISA).
Main Results:
- The overall median fecal calprotectin concentration was 13.6 microg/g.
- Median concentrations varied by age group: 28.2, 13.5, 9.9, and 14.6 microg/g for the respective age brackets.
- 89% of children had levels below 50 microg/g; higher levels in a subset prompted repeat testing, revealing transient elevations except in one case of proctitis.
Conclusions:
- The adult fecal calprotectin cutoff of <50 microg/g is applicable to children aged 4-17 years.
- Fecal calprotectin levels exceeding 50 microg/g in children warrant further investigation for gastrointestinal inflammation.
- This study provides essential reference data for interpreting pediatric fecal calprotectin results.
Background:
Calprotectin is a protein abundant in neutrophils. Fecal calprotectin can be used as a marker of gastrointestinal inflammation, and an improved assay has recently been developed. The aim of this study was to establish reference values for fecal calprotectin in healthy children aged between 4 and 17 years.
Methods:
Fecal samples were obtained from 117 healthy children classified into four age groups: 4 to 6 years, 7 to 10 years, 11 to 14 years, and 15 to 17 years. A health questionnaire was used to ensure that these children fulfilled the inclusion criterion and did not have intercurrent disease, nasal or menstrual bleeding, or nonsteroidal anti-inflammatory drug medication before the sampling period. Calprotectin was analyzed using a quantitative enzyme-linked immunosorbent assay (Calprest, Eurospital SpA, Trieste, Italy). Children with fecal calprotectin values >50 microg/g were asked to deliver an additional sample.
Results:
The overall median fecal calprotectin concentration was 13.6 microg/g (95% confidence interval, 9.9-19.5 microg/g) in the 117 children. In the different age groups, 4 to 6 years, 7 to 10 years, 11 to 14 years, and 15 to 17 years, the median calprotectin concentrations were 28.2, 13.5, 9.9, and 14.6 microg/g, respectively. Of these children, 104 (89%) had a concentration <50 microg/g. The remaining 13 children with a calprotectin concentration >50 microg/g delivered one additional fecal sample. All showed a lower concentration in the second sample except for one teenager who later proved to have proctitis.
Conclusions:
The suggested cutoff level for adults (<50 microg/g) can be used for children aged from 4 to 17 years regardless of sex. A fecal calprotectin concentration >50 microg/g warrants follow-up.
