Guidance on the interpretation of faecal calprotectin levels in children
Martina Orfei1, Marco Gasparetto1, Kai O Hensel1,2
1Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cambridge University Hospitals, Cambridge, United Kingdom.
Insights
Faecal calprotectin (FCP) testing in children can lead to unnecessary referrals. A higher FCP threshold, especially for infants, could improve diagnostic accuracy and reduce redundant investigations for suspected inflammatory bowel disease (IBD).
Area of Science:
- Paediatric Gastroenterology
- Clinical Diagnostics
- Biomarker Research
Background:
- Faecal calprotectin (FCP) is a key predictor of inflammatory bowel disease (IBD) in children with gastrointestinal symptoms.
- Current reference values (< 50 μg/g) and age-related FCP variations lead to numerous unnecessary investigations and specialist referrals.
- This study evaluates paediatric FCP levels, their diagnostic utility, and current referral pathways.
Purpose of the Study:
- To assess the diagnostic value of faecal calprotectin (FCP) in paediatric patients with gastrointestinal symptoms.
- To analyze the impact of age on FCP levels in children.
- To propose optimized referral guidelines for suspected inflammatory bowel disease (IBD) to reduce healthcare costs and patient burden.
Main Methods:
- Analysis of two cohorts: 2788 FCP measurements and 373 FCP values with clinical data from referred children.
- Comparison of FCP levels in children under 1 year versus older children.
- Evaluation of IBD diagnosis rates based on FCP levels and clinical symptoms in referred paediatric patients.
Main Results:
- 47% of paediatric FCP levels exceeded 50 μg/g, and 15% were ≥ 250 μg/g.
- Children under 1 year exhibited significantly higher FCP levels (p < 0.001).
- Only 6.7% of children with FCP < 250 μg/g (or 8.6% with FCP < 600 μg/g) were diagnosed with IBD, often presenting with severe symptoms or abnormal blood tests. 76% referred solely for elevated FCP (> 50 μg/g) did not have IBD.
Conclusions:
- Children with FCP < 600 μg/g and lacking IBD-suggestive symptoms are unlikely to have the condition.
- Implementing a higher FCP reference value could significantly reduce redundant investigations and specialist referrals, improving cost-effectiveness.
- A revised guideline for specialist referrals based on FCP levels and clinical presentation is proposed to optimize paediatric IBD diagnosis.
Background:
Faecal calprotectin (FCP) is a powerful tool to predict inflammatory bowel disease (IBD) in patients with gastrointestinal symptoms. In the paediatric patient population, the reference value of < 50 μg/g and the influence of age on FCP levels result in a high number of redundant investigations and specialist referrals. We assessed paediatric FCP levels, their diagnostic value and corresponding referral pathways from primary and secondary care.
Methods:
We analysed two cohorts from a precisely defined catchment area: one consisted of all FCPs measured in this area (n = 2788). The second cohort-a subset of the first cohort-consisted of FCP values and corresponding clinical data from children who were referred for possible IBD to our department (n = 373).
Results:
In the first cohort, 47% of FCP levels were > 50 μg/g, 15% were ≥ 250 μg/g. Children < 1y had significantly (p < 0.001) higher FCP than older children. In the second cohort, 6.7% of children with an FCP of < 250 μg/g (or 8.6% with an FCP of < 600 μg/g) had IBD-all featured symptoms suggestive of IBD (e.g. bloody diarrhoea, nocturnal abdominal pain, weight loss) or abnormal blood tests. 76% of patients in whom raised FCP (> 50 μg/g) was the sole reason for being referred for suspected IBD did not have IBD.
Conclusion:
Children with an FCP < 600 μg/g and without matching symptoms suggestive of IBD are unlikely to have IBD. A higher FCP reference value may provide cost-effective improvement that could avoid redundant investigations and specialist referrals. A guideline for specialist referrals is proposed.
