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Fecal Lactoferrin: Reliable Biomarker for Intestinal Inflammation in Pediatric IBD
Stephan Buderus1, James H Boone2, Michael J Lentze3
1Department of Pediatrics, St. Marien-Hospital, GFO-Kliniken Bonn, Robert-Koch-Straße 1, 53115 Bonn, Germany.
Insights
Fecal lactoferrin (FL) is a sensitive biomarker for detecting pediatric inflammatory bowel disease (IBD), outperforming CRP. Normal FL levels effectively rule out intestinal inflammation in children.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Diagnostics
- Biomarker Research
Background:
- Early diagnosis is crucial for optimal management of pediatric inflammatory bowel disease (IBD).
- Current biomarkers like C-reactive protein (CRP) have limitations in sensitivity for detecting intestinal inflammation in children.
- Fecal lactoferrin (FL) is being investigated as a non-invasive biomarker for intestinal inflammation.
Purpose of the Study:
- To compare the diagnostic accuracy of fecal lactoferrin (FL) against C-reactive protein (CRP) in pediatric patients with new-onset IBD.
- To assess the correlation between FL levels and disease severity in Crohn's disease (CD) patients.
Main Methods:
- Fecal lactoferrin (FL) measured by ELISA in stool samples from pediatric patients prior to endoscopy.
- Serum C-reactive protein (CRP) levels were measured.
- Patients were categorized into three groups: Crohn's disease (CD), ulcerative colitis (UC), and non-IBD controls.
Main Results:
- Fecal lactoferrin (FL) demonstrated higher sensitivity (100%) and negative predictive value (100%) compared to CRP (75% sensitivity, 69% NPV) for detecting IBD.
- FL showed high specificity (95%) and positive predictive value (97.3%), while CRP had 100% specificity and 100% PPV.
- In pediatric CD patients, FL levels positively correlated with the endoscopic severity score (SES-CD).
Conclusions:
- Elevated fecal lactoferrin (FL) accurately indicates intestinal inflammation in pediatric IBD patients, even when CRP levels are normal.
- Normal FL levels provide a high degree of confidence in excluding intestinal inflammation in children.
- FL is a promising, highly sensitive biomarker for the diagnosis and assessment of pediatric IBD.
Abstract:
Background. Optimal management of pediatric patients with inflammatory bowel disease (IBD) requires early diagnosis. Aim of the study is to compare fecal lactoferrin (FL) as biomarker of intestinal inflammation to CRP in pediatric patients with new-onset IBD. Methods. FL was measured by ELISA in stool specimens collected prior to endoscopy for IBD (IBD-SCAN; TechLab, Blacksburg; normal < 7.3 µg/g feces). CRP was detected in serum (normal < 5 mg/L). Three patient groups were determined: n = 21 (mean age 13.2) with Crohn's disease (CD), n = 15 (mean age 10.9) with ulcerative colitis (UC), and n = 20 (mean age 11.9) in whom IBD was ruled out. In CD patients the endoscopic severity score SES-CD was correlated with the FL levels. Results. (Mean ± SEM). CRP levels were 27.18 ± 4.2 for CD-cases, 20.8 ± 9.5 for UC, and 0.24 ± 0.06 for non-IBD patients. FL levels were 313.6 ± 46.4 in CD, 370.7 ± 46.9 in UC, and 1.3 ± 0.5 in non-IBD patients. Sensitivity of CRP to detect IBD was 75% with specificity of 100%, positive predictive value of 100%, and negative predictive value of 69%. Sensitivity of FL was 100% with specificity of 95%, positive predictive value of 97.3%, and negative predictive value of 100%. In CD, FL levels correlated positively (R (2) = 0.42) with disease severity as judged by the SES-CD. Conclusions. Elevated FL corresponds to intestinal inflammation, even in patients with normal CRP. With high probability, normal FL excludes intestinal inflammation.
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