Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2015; 21(48): 13566-13573
Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13566
Fecal calprotectin correlated with endoscopic remission for Asian inflammatory bowel disease patients
Wei-Chen Lin, Jau-Min Wong, Chien-Chih Tung, Ching-Pin Lin, Jen-Wei Chou, Horng-Yuan Wang, Ming-Jium Shieh, Chin-Hao Chang, Heng-Hsiu Liu, Shu-Chen Wei, Taiwan Society of Inflammatory Bowel Disease Multicenter Study
Wei-Chen Lin, Horng-Yuan Wang, Division of Gastroenterology, Department of internal Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan
Jau-Min Wong, Ming-Jium Shieh, Shu-Chen Wei, Departments of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
Chien-Chih Tung, Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei 100, Taiwan
Ching-Pin Lin, Division of Gastroenterology, Department of internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Jen-Wei Chou, Division of Gastroenterology, Department of internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
Chin-Hao Chang, Medical Research, National Taiwan University Hospital, Taipei 100, Taiwan
Heng-Hsiu Liu, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan
Author contributions: Lin WC, Wong JM, Tung CC, Lin CP, Chou JW, Wang HY and Wei SC conceptualized and designed the study, acquired data, statistically analyzed and interpreted data, drafted the manuscript, and critically revised the manuscript for important intellectual content; Shieh MJ, Chang CH, and Liu HH analyzed and interpreted the data, drafted the manuscript, and critically revised the manuscript for important intellectual content; all authors read and approved the final manuscript.
Supported by Liver Disease Prevention and Treatment Research Foundation, Taiwan; as well as the National Research Program for Biopharmaceuticals at the Ministry of Science and Technology of Taiwan; MOST 103-2325-B-002-033.
Institutional review board statement: The study was reviewed and approved by the National Taiwan University Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No author of this article had a financial conflict of interest relating to the article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at shuchenwei@ntu.edu.tw.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Shu-Chen Wei, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. shuchenwei@ntu.edu.tw
Telephone: +886-2-23123456-65768 Fax: +886-2-23947927
Received: July 1, 2015
Peer-review started: July 4, 2015
First decision: July 19, 2015
Revised: August 6, 2015
Accepted: September 14, 2015
Article in press: September 15, 2015
Published online: December 28, 2015
Abstract

AIM: To evaluate the correlation between fecal calprotectin (fC), C-reactive protein (CRP), and endoscopic disease score in Asian inflammatory bowel disease (IBD) patients.

METHODS: Stool samples were collected and assessed for calprotectin levels by Quantum Blue Calprotectin High Range Rapid test. Crohn’s disease endoscopic index of severity (CDEIS) and ulcerative colitis endoscopic index of severity (UCEIS) were used for endoscopic lesion scoring.

RESULTS: A total of 88 IBD patients [36 patients with Crohn’s disease (CD) and 52 with ulcerative colitis (UC)] were enrolled. For CD patients, fC correlated with CDEIS (r = 0.465, P = 0.005) and CRP (r = 0.528, P = 0.001). fC levels in UC patients correlated with UCEIS (r = 0.696, P < 0.0001) and CRP (r = 0.529, P = 0.0005). Calprotectin could predict endoscopic remission (CDEIS < 6) with 50% sensitivity and 100% specificity (AUC: 0.74) in CD patients when using 918 μg/g as the cut-off. When using 191 μg/g as the cut-off in UC patients, calprotectin could be used for predicting endoscopic remission (UCEIS < 3) with 88% sensitivity and 75% specificity (AUC: 0.87).

CONCLUSION: fC correlated with both CDEIS and UCEIS. fC could be used as a predictor of endoscopic remission for Asian IBD patients.

Keywords: Inflammatory bowel disease, Endoscopic score, Fecal calprotectin, Crohn’s disease, Ulcerative colitis

Core tip: Mucosal healing is the goal in treating inflammatory bowel disease patients, and endoscopic examination remains the gold standard for evaluating mucosal status. Our results provide more evidence that fecal calprotectin (fC) correlates well with mucosal disease activity by using endoscopic disease score of ulcerative colitis endoscopic index of severity (UCEIS) and Crohn's disease endoscopic index of severity (CDEIS). The correlation of fC was higher in UCEIS than in CDEIS. fC could be used as a predictor of endoscopic remission for Asian inflammatory bowel disease patients.