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Fecal calprotectin and clinical disease activity in pediatric ulcerative colitis
Kaija-Leena Kolho1, Dan Turner
1Children's Hospital, Helsinki University Central Hospital, P.O. Box 281, 00029 Helsinki, Finland.
Insights
Fecal calprotectin is often elevated in active pediatric ulcerative colitis (UC). However, high levels during remission in UC patients don't necessarily require treatment escalation.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease
- Biomarker Research
Background:
- Pediatric ulcerative colitis (UC) management relies on clinical assessments.
- Fecal calprotectin is a sensitive marker for intestinal inflammation.
- The utility of fecal calprotectin in pediatric UC remission requires further clarification.
Purpose of the Study:
- To investigate the correlation between fecal calprotectin levels and clinical disease activity in pediatric UC.
- To evaluate the predictive value of fecal calprotectin for clinical outcomes in pediatric UC.
Main Methods:
- A cohort of 37 pediatric UC patients with 62 assessments was studied.
- Fecal calprotectin was measured using the PhiCal ELISA Test.
- The Pediatric Ulcerative Colitis Activity Index (PUCAI) was used to assess clinical activity.
Main Results:
- Fecal calprotectin was elevated in 91% of patients with active UC (PUCAI ≥ 10).
- In clinical remission, 23% of patients exhibited very high calprotectin levels (>1000 μg/g).
- A fecal calprotectin cut-off of 800 μg/g best predicted poor 3-month outcomes (AUC 0.71).
Conclusions:
- Elevated fecal calprotectin in pediatric UC remission has unclear clinical significance.
- Current evidence does not support escalating therapy based solely on elevated calprotectin during remission.
- Further research is needed to understand the implications of persistent fecal calprotectin elevation in pediatric UC remission.
Abstract:
Objective. To explore fecal calprotectin levels in pediatric ulcerative colitis (UC) in relation with the validated clinical activity index PUCAI. Methods. This study included all 37 children (median age 14 years) with UC who had calprotectin measured (PhiCal ELISA Test) by the time of PUCAI assessment at the Children's Hospital of Helsinki in a total of 62 visits. Calprotectin values <100 μ g/g of stool were considered as normal. The best cut-off value of each measure to predict 3-month clinical outcome was derived by maximizing sensitivity and specificity. Results. In clinically active disease (PUCAI ≥ 10), calprotectin was elevated in 29/32 patients (91% sensitivity). When in clinical remission, 26% (8/30) of the children had normal calprotectin but 7 (23%) had an exceedingly high level (>1000 μ g/g). The best cut-off value for calprotectin for predicting poor outcome was 800 μ g/g (sensitivity 73%, specificity 72%; area under the ROC curve being 0.71 (95%CI 0.57-0.85)) and for the PUCAI best cut-off values >10 (sensitivity 62%, specificity 64%; area under the ROC curve 0.714 (95%CI 0.58-0.85)). Conclusion. The clinical relevance of somewhat elevated calprotectin during clinical remission in pediatric UC is not known and, until further evidence accumulates, does not indicate therapy escalation.
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