Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn's disease

Abstract

Background and aims: The clinical course of inflammatory bowel disease is characterised by a succession of relapses and remissions. The aim of our study was to assess whether the predictive value of faecal calprotectin-a non-invasive marker of intestinal inflammation-for clinical relapse is different in ulcerative colitis (UC) and Crohn's disease (CD).

Methods: Seventy nine consecutive patients with a diagnosis of clinically quiescent inflammatory bowel disease (38 CD and 41 UC) were followed for 12 months, undergoing regular clinical evaluations and blood tests. A single stool sample was collected at the beginning of the study from each patient and the calprotectin concentration was assessed by a commercially available enzyme linked immunoassay.

Results: In CD, median calprotectin values were 220.1 mug/g (95% confidence interval (CI) 21.7-418.5) in those patients who relapsed during follow up, and 220.5 mug/g (95% CI 53-388) in non-relapsing patients (p=0.395). In UC, median calprotectin values were 220.6 mug/g (95% CI 86-355.2) and 67 microg/g (95% CI 15-119) in relapsing and non-relapsing patients, respectively (p<0.0001). The multivariate Cox (proportional hazard) regression model, after adjustment for possible confounding variables, showed a twofold and 14-fold increase in the relapse risk, respectively, in those patients with CD and UC in clinical remission who had a faecal calprotectin concentration higher than 150 microg/g.

Conclusions: Faecal calprotectin proved to be an even stronger predictor of clinical relapse in UC than in CD, which makes the test a promising non-invasive tool for monitoring and optimising therapy.

Figures

Figure 1

(A). Receiver operating characteristic (ROC) curve for faecal calprotectin in predicting the relapse rate in Crohn’s disease. The area under the curve was 0.58 (95% confidence interval (CI) CI 0.40–0.77). (B). ROC curve for faecal calprotectin in predicting the relapse rate in ulcerative colitis. The area under the curve was 0.87 (95% CI 0.77–0.98).

Figure 2

(A) Kaplan-Meier survivor curves for Crohn’s disease patients, with values for calprotectin above and below 150 μg/g. Log rank test for equality of survivor functions, p value = 0.0432. (B) Kaplan-Meier survivor curves for ulcerative colitis patients with values of calprotectin above and below 150 μg/g. Log rank test for equality of survivor functions, p value = 0.0000.