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Assessing Histological Inflammatory Activity in Patients With Ulcerative Colitis: A Diagnostic Accuracy Study Testing
Jost Langhorst1,2, Lana Kairey1, Angela Oberle3
1Department of Internal and Integrative Medicine, Klinikum Bamberg, Bamberg, Germany.
Crohn'S & Colitis 360
|February 13, 2023
Summary
Noninvasive fecal biomarkers calprotectin (FC) and lactoferrin (FL) show moderate accuracy in assessing ulcerative colitis (UC) histological activity. These tests can help monitor UC patients, differentiating remission from active disease.
Area of Science:
- Gastroenterology
- Clinical Diagnostics
- Inflammatory Bowel Disease Research
Background:
- Histological remission is the optimal outcome for ulcerative colitis (UC) treatment.
- Noninvasive fecal biomarkers like calprotectin (FC) and lactoferrin (FL) are being explored as alternatives to invasive histological assessments.
- This study evaluated the diagnostic performance of FC and FL against established histological indices.
Purpose of the Study:
- To assess the diagnostic accuracy of fecal calprotectin (FC) and lactoferrin (FL) in identifying histological disease activity in UC patients.
- To compare the performance of FC and FL with the Nancy Index (NI) and Riley Index (RI) histological scoring systems.
- To determine the effectiveness of FC and FL as noninvasive tools for monitoring UC activity.
Main Methods:
- Retrospective analysis of 226 UC patients' data from 2002-2017.
- Colonoscopies with biopsies scored using Nancy Index (NI) and Riley Index (RI) by pathologists.
- Stool samples collected within 7 days of colonoscopy for FC and FL analysis.
- Diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV, accuracy) calculated for FC and FL against NI (≥2) as the reference standard.
Main Results:
- Fecal biomarkers (FC, FL) showed moderate correlation with histological indices (NI, RI).
- FC and FL concentrations were significantly higher in patients with active histological disease (NI ≥2) compared to inactive disease (NI ≤1).
- Receiver operating characteristic analysis indicated moderate diagnostic accuracy for FC (0.76) and FL (0.73). Optimized cutoffs improved accuracy (FC: 69.9%, FL: 71.7%).
Conclusions:
- Fecal calprotectin and lactoferrin correlate with histological disease activity in UC.
- These noninvasive biomarkers effectively differentiate between histological remission and moderate-to-severe disease activity.
- The inexpensive and noninvasive nature of FC and FL supports their utility in routine clinical monitoring of UC patients.
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