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Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn's disease patients
Alice Jane Foster1, Matthew Smyth1, Alam Lakhani1
1Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, Vancouver, BC V6H 3V4, Canada.
Insights
Serial fecal calprotectin testing effectively predicts relapse in children with Crohn's disease (CD). Levels above 250 μg/g indicate a high risk of symptomatic relapse within three months, guiding monitoring strategies.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Biomarker Discovery
Background:
- Monitoring asymptomatic children with Crohn's disease (CD) is crucial for early detection of exacerbations.
- Current monitoring strategies require refinement for optimal patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of serial fecal calprotectin measurements in pediatric CD patients.
- To determine if fecal calprotectin can predict intestinal inflammation and disease relapse.
Main Methods:
- A prospective longitudinal cohort study involving 53 children with CD on infliximab therapy in clinical remission.
- Serial fecal calprotectin measurements were taken over 18 months.
- Clinical and biochemical disease activity were assessed using established indices and markers.
Main Results:
- Eighteen patients (34%) experienced a clinical relapse during the study period.
- Higher baseline fecal calprotectin levels were observed in patients who relapsed (723 μg/g vs. 244 μg/g, P=0.02).
- Fecal calprotectin levels > 250 μg/g accurately predicted clinical flares within 3 months (AUC=0.86).
Conclusions:
- Routine fecal calprotectin testing is a valuable tool for predicting relapse in pediatric CD patients in remission.
- A threshold of > 250 μg/g for fecal calprotectin reliably predicts relapse within three months.
- These findings can inform updated monitoring guidelines for pediatric CD management.
Background:
Asymptomatic children with Crohn's disease (CD) require ongoing monitoring to ensure early recognition of a disease exacerbation.
Aim:
In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease relapse.
Methods:
In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn's Disease Activity Index, C-reactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 mo.
Results:
53 children were included and eighteen patients (34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median (interquartile range), relapse 723 μg/g (283-1758) vs 244 μg/g (61-627), P = 0.02]. Fecal calprotectin levels > 250 μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo (area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).
Conclusion:
Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.