Urinary prostaglandin metabolites evaluation for activity monitoring in inflammatory bowel disease

Inflammatory bowel diseases cause chronic intestinal inflammation, including Crohn's disease (CD) and ulcerative colitis (UC). Prostaglandin E-major urinary metabolite (PGE-MUM) is a urine biomarker for disease activity in IBD. This study evaluated PGE-MUM performance for predicting an active disease in patients with CD and UC. We also compared PGE-MUM performances to fecal calprotectin (FC) and blood C-reactive protein (CRP). A total of 214 patients were included from two University Hospitals in Italy and France. One hundred and twenty-one patients with CD and 86 with UC were included. We compared PGE-MUM, FC, and CRP in patients. In the CD group, PGE-MUM AUC for predicting an active disease was 0.659 with 46% sensitivity and 80% specificity. FC AUC was 0.957 with 98% sensitivity and 80% specificity. CRP AUC was 0.619, with 49% sensitivity and 76% specificity. In the UC group, PGE-MUM AUC was 0.693 with 37% sensitivity and 97% specificity. FC AUC was 0.916 with 78% sensitivity and 95% specificity. FC was superior to the PGE-MUM in CD (p < 0.0001) and UC (p = 0.003), indicating a higher performance in predicting an active disease. The Combination of both markers gave an AUC of 0.926 in UC and 0.952 in CD, comparable to that observed with FC alone. Cluster analysis revealed distinct inflammatory patterns with compact and homogenous character, with two endophenotypes based on biomarkers for UC and three for CD showing a between-class variance of 52% and 65%, respectively. PGE-MUM and FC are associated with clinical disease activity in UC and CD. PGE-MUM does not perform better than FC alone. These two markers' combination showed three distinct patterns in CD and two in UC. Combining PGE-MUM and FC may improve the assessment of inflammation profiles in IBD and constitute a promising way for personalized approaches.