Relevance of fecal calprotectin and lactoferrin in the post-operative management of inflammatory bowel diseases

Table 1 Studies evaluating fecal calprotectin and lactoferrin in operated Crohn’s disease patients

Ref.	FC/FL	Method	No. of patients	Aim	Best cut-off	Sens %	Spec %	Main findings
Scarpa et al[17]	FC and FL	ELISA	63 (22 endoscopy)	Role as marker of intestinal inflammation after ileocolonic resection	/	/	/	High FC and FL levels at long-term follow-up after resection even in case of clinical remission Correlation between FL and CRP Higher levels of FL in case of clinical recurrence
Ruffolo et al[18]	FL	ELISA (IBD-scan)	36	Correlation with systemic inflammation and prognostic value in terms of need of surgery for recurrence	/	/	/	FL as expression of subclinical intestinal inflammation (through IL6-CRP cascade)
Lamb et al[19]	FC and FL	ELISA (PhiCal) ELISA (IBD-Scan)	13 (prospective cohort) 104 (cross-sectional cohort; 43 endoscopy)	Evaluation of the course of FL and FC after ileocaecal resection. Identification of postoperative recurrence; Correlation between FC and FL	/	/	/	Prospective cohort: Normalization of fecal markers by 2 mo after surgery in uncomplicated patients Cross-sectional cohort: Significant correlation between FC and FL Significant correlation of fecal markers with HBI No significant difference between the FC and FL values in those with endoscopic recurrence and those without
Yamamoto et al[20]	FC and FL	ELISA (Cell Science) and Colloidal Gold Agglutination reagent (Auto Lf-Plus, respectively)	20	Evaluation of the relationship between endoscopic activity and FC/FL Assessment of Fc and FL predictive value for future clinical recurrence	FC 170 mg/g FL 140 mg/g (for prediction of clinical relapse)	83 67	93 71	Significant correlation between FC and FL Correlation with endoscopic activity Ability to predict clinical post-operative recurrence
Orlando et al[21]	FC	ELISA	50 (39 endoscopy)	Evaluation of the one year postsurgical endoscopic recurrence	200 mg/L	63	75	FC > 200 mg can be an indication to colonoscopy in patients with negative ultrasound in order to detect early recurrence
Lasson et al[22]	FC	ELISA (Buhlmann)	30	Correlation of FC with the endoscopic findings one year after ileocaecal resection Evaluation of the variation of FC in individual patients during 6 mo prior to the ileocolonoscopy	/	/	/	No difference in the concentrations of FC between patients in endoscopic remission and patients with recurrence one year after ileocaecal resection Significant variability of FC concentrations over time
Wright et al[25]	FC	ELISA (fCAL, Buhlmann)	135 (319 fecal samples)	To assess whether monitoring FC can substitute endoscopy and be used as surrogate marker of recurrent post-operative disease	100 μg/g	89	58	FC correlated with the presence of recurrent disease at endoscopy and with endoscopic severity FC has sufficient sensitivity and negative predictive values to monitor for recurrence FC can be used to monitor response to treatment after detection of recurrence FC has better diagnostic performance than CRP and clinical index of activity
Lobaton et al[27]	FC	ELISA (Buhlmann) FC-QPOCT (Quantum Blue)	115 (29 resected)	To evaluate the performance of a new rapid test for FC in predicting endoscopic remission (in both operated and non-operated CD patients)	283 μg/g	67	72	Significant correlation between ELISA and rapid test FC was able to discriminate between the presence or absence of endoscopic recurrence, but not distinguish different levels of severity

CD: Crohn’s disease; CRP: C-reactive protein; ELISA: Enzyme-linked immunoassay; FC: Fecal calprotectin; FL: Fecal lactoferrin; HBI: Harvey Bradshaw Index; Sens: Sensitivity; Spec: Specificity.