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Published on: February 1, 2012
Fecal calprotectin level is nonlinearly associated with GI pathogen detection in patients with and without
Kira L Newman1, Peter D R Higgins1
1Department of Medicine, University of Michigan , Ann Arbor, Michigan, USA.
Abstract:
Fecal calprotectin (FCP) is used to monitor inflammatory bowel disease (IBD) activity and can also be elevated in gastrointestinal infections. Our study's objective was to quantify the relationship between FCP levels and lab-confirmed infections in people with and without IBD. We performed a cross-sectional study at a tertiary-care center of all encounters during which FCP and gastrointestinal pathogen polymerase-chain reaction (GI PCR) panel testings were conducted. Using non-parametric tests and quantile regression, we compared the FCP levels by IBD status and pathogen detection. There were 3,347 encounters with FCP and GI PCR testings from 2,780 unique individuals between 1 August 2016 and 17 February 2022. Overall, 54.4% had IBD (n = 1,819). Pathogens were detected in 744 encounters (22.2%), and the detection rate did not differ by IBD status. Median FCP without IBD was significantly elevated when a pathogen was detected (64 vs 41 mg/kg, P = 0.0003, normal ≤50.0 mg/kg), but FCP with IBD was not significantly elevated when a pathogen was detected (299 vs 255 mg/kg, P = 0.207). In quantile regression adjusted for age and IBD, pathogen detection was only significantly associated with higher FCP in the lower two quartiles, though IBD remained significantly associated with higher FCP at all levels (P > 0.001). Pathogen detection by GI PCR is associated with elevated FCP, though this relationship is nonlinear and varies by IBD status. Our findings indicate that FCP may be an adjunct to, but not a substitute for, stool pathogen testing.
Insights
Fecal calprotectin (FCP) can indicate gastrointestinal infections, but its elevation varies with inflammatory bowel disease (IBD) status. Pathogen detection is linked to higher FCP, especially in non-IBD patients, suggesting FCP aids, but doesn't replace, infection testing.
Area of Science:
- Gastroenterology
- Clinical Diagnostics
- Microbiology
Background:
- Fecal calprotectin (FCP) is a biomarker for inflammatory bowel disease (IBD) activity.
- Elevated FCP levels can also indicate gastrointestinal infections.
- The relationship between FCP, IBD status, and infection requires further quantification.
Purpose of the Study:
- To quantify the association between FCP levels and laboratory-confirmed gastrointestinal infections.
- To investigate how this association differs in patients with and without IBD.
- To determine if FCP can serve as a reliable indicator of infection in IBD patients.
Main Methods:
- Cross-sectional study analyzing encounters with FCP and gastrointestinal pathogen polymerase-chain reaction (GI PCR) testing.
- Non-parametric tests and quantile regression used for data analysis.
- Comparison of FCP levels based on IBD status and pathogen detection.
Main Results:
- A total of 3,347 encounters were analyzed; 54.4% of individuals had IBD.
- Pathogens were detected in 22.2% of encounters, with no difference in detection rates between IBD and non-IBD groups.
- In non-IBD patients, median FCP was significantly higher with pathogen detection (64 vs 41 mg/kg).
- In IBD patients, median FCP was not significantly elevated with pathogen detection (299 vs 255 mg/kg).
- Quantile regression showed pathogen detection associated with higher FCP in lower quartiles, while IBD consistently associated with higher FCP.
Conclusions:
- Pathogen detection by GI PCR is associated with elevated FCP, but the relationship is nonlinear and influenced by IBD status.
- FCP elevation due to infection is more pronounced in individuals without IBD.
- FCP can be an adjunct tool for assessing gastrointestinal infections but should not replace stool pathogen testing.
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