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Concentration of fecal calprotectin in 11,255 children aged 0-18 years
Kaija-Leena Kolho1, Henrik Alfthan2
1Children´s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
Fecal calprotectin levels are significantly higher in infants under one year old. Beyond the first year, levels decrease and remain low and comparable in children and adolescents, aiding in inflammation assessment.
Area of Science:
- Pediatric Gastroenterology
- Clinical Chemistry
- Inflammatory Biomarkers
Background:
- Fecal calprotectin is a key indicator of intestinal inflammation.
- Concerns exist regarding elevated fecal calprotectin in young children potentially limiting its diagnostic utility.
- Understanding age-related variations is crucial for accurate interpretation.
Purpose of the Study:
- To investigate age-related variations in fecal calprotectin levels in children aged 0-18 years.
- To determine if early-life calprotectin levels differ significantly from older children and adolescents.
- To provide data for improved interpretation of fecal calprotectin in pediatric populations.
Main Methods:
- Retrospective analysis of 11,255 fecal calprotectin measurements from a southern Finland laboratory (2014-2017).
- Inclusion of the first measurement per child (0-18 years); exclusion of repeat measurements.
- Quantification using an ELISA kit on automated pipetting analyzers.
Main Results:
- Median fecal calprotectin was 51 mg/kg in infants (<1 year), with a 95th percentile of 648 mg/kg.
- Levels in infants were 3-4 times higher than in children aged 1-10 years.
- Median levels in children aged 11-18 years ranged from 11-19 mg/kg, with increasing proportions above 100 mg/kg with age.
Conclusions:
- Fecal calprotectin levels are substantially higher in infants compared to older children.
- Beyond the first year of life, fecal calprotectin values are generally low and consistent across childhood and adolescence.
- These findings support the use of fecal calprotectin as a reliable marker for intestinal inflammation in children over one year old.
Objectives:
Fecal calprotectin is a valued surrogate marker for intestinal inflammation. It has been argued that calprotectin levels are higher in early age than in later life hampering the use of calprotectin in young children.
Subjects And Methods:
To study age-related variation, we used data from our laboratory information system on consecutive, unselected fecal calprotectin measurements from 2014 to 2017 in all children aged 0 to 18 years. From each individual, the first measurement was included and repeated measurements were excluded. Fecal calprotectin was quantitated in the major clinical laboratory in southern Finland, HUSLAB with an ELISA kit from Calpro AS (Calpro/Calprolab, Oslo, Norway). Currently, the assay is performed on two automatic pipetting analysers (Dynex DS2, Chantilly, USA) according to the instructions of the manufacturer.
Results:
There were altogether 11,255 fecal calprotectin results from as many children. The median level of fecal calprotectin was 51 mg/kg in infants < 1 year of age (95th percentile 648 mg/kg; n = 239). This was 3-4-fold higher when compared to yearly age groups from 1 to 10 years (total number of children included 5,691). Across yearly age groups from 11 to 18, the median values varied from 11 to 19 mg/kg (total number of included children 5,325). The proportion of samples above the routine cut-off for an elevated concentration >100 mg/kg increased with increasing age.
Conclusions:
Fecal calprotectin values in children beyond the first year of life are in general low and comparable in children and adolescents.
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