Systematic Review with Meta-Analysis: Fecal Calprotectin as a Surrogate Marker for Predicting Relapse in Adults with Ulcerative Colitis

Jiajia Li, Xiaojing Zhao, Xueting Li, Meijiao Lu, Hongjie Zhang, Jiajia Li, Xiaojing Zhao, Xueting Li, Meijiao Lu, Hongjie Zhang

Abstract

The clinical course of ulcerative colitis (UC) is featured by remission and relapse, which remains unpredictable. Recent studies revealed that fecal calprotectin (FC) could predict clinical relapse for UC patients in remission, which has not yet been well accepted. To detect the predictive value of FC for clinical relapse in adult UC patients based on updated literature, we carried out a comprehensive electronic search of PubMed, Web of Science, Embase, and the Cochrane Library to identify all eligible studies. Diagnostic accuracy including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and pooled area under the receiver operating characteristic (AUROC) was calculated using a random effects model. Heterogeneity across studies was assessed by the I 2 metric. Sources of heterogeneity were detected using subgroup analysis. Metaregression was used to test potential factors correlated to DOR. Publication bias was assessed using Deek's funnel plots. In our study, 14 articles enrolling a total of 1110 participants were finally included, and all articles underwent a quality assessment. Pooled sensitivity, specificity, PLR, and NLR with 95% confidence intervals (CIs) were 0.75 (95% CI: 0.70-0.79), 0.77 (95% CI: 0.74-0.80), 3.45 (95% CI: 2.31-5.14), and 0.37 (95% CI: 0.28-0.49) respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.82, and the diagnostic odds ratio was 10.54 (95% CI: 6.16-18.02). Our study suggested that FC is useful in predicting clinical relapse for adult UC patients in remission as a simple and noninvasive marker.

Figures

Figure 1
Figure 1
Study flow diagram showing the process of selecting studies concerning the diagnostic accuracy of FC in predicting relapse among adult UC patients.
Figure 2
Figure 2
QUADAS-2 risk of bias assessment. +, high; −, low; ?, unclear.
Figure 3
Figure 3
Forest plots of pooled sensitivity of FC in predicting relapse of UC in one-year follow-up (a). Forest plots of pooled specificity of FC in predicting relapse of UC (b).
Figure 4
Figure 4
Symmetrical summary receiver operator curve (sROC) for all 14 studies. The size of the circle represents the sample size of each study included in the meta-analysis.
Figure 5
Figure 5
Deeks' funnel plot.

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