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Fecal calprotectin is useful in predicting disease relapse in pediatric inflammatory bowel disease
Dorota Walkiewicz1, Steven L Werlin, Daryl Fish
1Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Insights
Fecal calprotectin (FC) levels are significantly higher in pediatric inflammatory bowel disease (IBD) patients compared to healthy children. Elevated FC levels can predict impending clinical relapse in children with Crohn's disease (CD).
Area of Science:
- Pediatric Gastroenterology
- Clinical Immunology
- Inflammatory Bowel Disease Research
Background:
- Fecal calprotectin (FC) is a noninvasive marker for intestinal inflammation in inflammatory bowel disease (IBD).
- Accurate assessment of disease activity and prediction of relapse are crucial for managing pediatric IBD.
- Understanding FC levels in relation to disease status is vital for optimizing patient care.
Purpose of the Study:
- To compare FC levels between pediatric IBD patients and healthy controls.
- To correlate FC levels with clinical disease activity in IBD.
- To evaluate the predictive value of FC for clinical relapse in pediatric IBD.
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) measured FC levels in stool samples from 97 IBD patients and 37 healthy controls.
- Disease activity assessed using Harvey-Bradshaw index (CD) and Physician's Global Assessment (PGA) (CD and UC).
- Kaplan-Meier analysis used to assess the risk of clinical relapse based on FC levels.
Main Results:
- IBD patients exhibited significantly higher FC levels than controls (P < 0.0001).
- FC levels were markedly elevated during active disease (relapse) compared to remission in both CD and ulcerative colitis (UC) (P < 0.0001).
- In Crohn's disease, 90% of relapses occurred with FC > 400 µg/g, while 89% of patients with FC < 400 µg/g remained in remission.
Conclusions:
- FC levels effectively differentiate active IBD from healthy controls in children.
- In pediatric Crohn's disease patients in remission, FC levels show potential for predicting imminent clinical relapse.
- FC serves as a valuable noninvasive tool for monitoring IBD activity and predicting relapse in pediatric populations.
Background:
Fecal calprotectin (FC) has been proposed as a noninvasive surrogate marker to determine the degree of intestinal inflammation and predicting relapse in patients with inflammatory bowel disease (IBD). The aim was to compare FC levels in IBD and healthy controls, to correlate FC levels with clinical disease activity, and to assess whether FC levels can be used to predict clinical relapse in children with IBD.
Methods:
Enzyme-linked immunosorbent assay (ELISA) determined levels of FC were measured in more than 1 stool samples (n) from 32 IBD patients (n = 97) and from 34 healthy controls (n = 37). Disease activity was assessed by the Harvey-Bradshaw index in Crohn's disease (CD) and by Physician's Global Assessment (PGA) in both CD and ulcerative colitis (UC). Clinical events were recorded up to 9 months following stool collection in CD patients. Wilcoxon rank sum test and Fisher's exact tests were used to compare FC levels in IBD patients and in control. Kaplan-Meyer analysis was used to determine a risk of clinical relapse in relation to FC levels.
Results:
The IBD group had higher FC levels (range 17-7500 g/g) compared with control (16-750 g/g, P < 0.0001). FC levels were higher during relapse (CD, 3214 +/- 2186; UC, 2819 +/- 1610) compared to remission (CD, 1373 +/- 1630; UC, 764 +/- 869; P < 0.0001). Among those with clinical relapse, 90% had FC levels more than 400 mug/g in CD. Eighty-nine percent of CD encounters with FC levels less than 400 mug/g remained in clinical remission.
Conclusions:
FC levels differentiate active IBD from controls. Among children with CD and in remission, FC levels may be useful in predicting impending clinical relapse.
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