Efficacy of noninvasive evaluations in monitoring inflammatory bowel disease activity: A prospective study in China

doi:10.3748/wjg.v23.i46.8235

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Dec 14, 2017 (publication date) through Apr 18, 2024

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World Journal of Gastroenterology

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1007-9327

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Prospective Study

World J Gastroenterol. Dec 14, 2017; 23(46): 8235-8247
Published online Dec 14, 2017. doi: 10.3748/wjg.v23.i46.8235

Table 1 Clinical and demographic characteristics of included patients n (%)

	CD	UC	IBS
Number of patients, n	92	44	25
Male	54 (58.7)	26 (59.1)	11 (44)
Median age at test (range)	29.5 (18-62)	38 (19-70)	35 (21-52)
Age at diagnosis (yr)			NA
A1 (< 16)	7 (7.6)	2 (4.5)
A2 (17-40)	69 (75.0)	27 (61.4)
A3 (> 40)	16 (17.4)	15 (34.1)
Disease location			NA
Ileum (L1)	22 (23.9)	NA
Colonic (L2)	10 (10.9)	NA
Ileum-Colonic (L3)	60 (65.2)	NA
Upper GI (L4)	9 (9.8)	NA
Rectum (E1)	NA	15 (34.1)
Distal colitis (E2)	NA	14 (31.8)
Extensive colitis (E3)	NA	15 (34.1)
Concomitant medications¹			NA
No medication	9 (9.8)	3 (6.8)
5-ASA	28 (30.4)	37 (84.1)
Corticosteroids	22 (23.9)	9 (20.5)
Immunosuppressants	39 (42.4)	1 (2.31)
Anti-TNF therapy	36 (39.1)	4 (9.1)
Previous IBD-related surgery: no/yes	69/23	NA	NA

¹Because therapy regimens overlapped, the total is not 100%. GI: Gastrointestinal; ASA: 5-aminosalicylic acid; TNF: Tumor necrosis factor; NA: Not applicable; IBS: Irritable bowel syndrome; CD: Crohn’s disease; UC: Ulcerative colitis.

Table 2 Descriptive statistics of noninvasive evaluations for endoscopy-based classification of inflammation for inflammatory bowel disease and irritable bowel syndrome patients

	CICD		CD-related surgery		UC		IBS
	Inactive, n = 21	Active, n = 35	Inactive, n = 15	Active, n = 10	Inactive, n = 12	Active, n = 33	n = 25
FC (µg/g)
Median	131.72¹³	1795.8¹²	142.97³	229.27²	45.31¹³	690.6¹²	9.9²³
Range	(0-658.71)	(264.64-2266.07)	(0.02-1805.0)	(0-1805.0)	(6.7-189.42)	(74.93-2266.01)	(0-385.4)
CDAI/CAI							NA
Median	63.12¹	168.45¹	81	135.64	1¹	6¹
Range	(32.2-155.0)	(46.8-364.0)	(37.8-192.8)	(38. 8-327.1)	(0-4)	(1-17)
CRP (mg/L)							NA
Median	0.48¹	20.57¹	2.1	4.37	0.39¹	4¹
Range	(0.10-12.88)	(0.2-79.8)	(0.13-134.6)	(0.10-41.20)	(0.04-2.1)	(0.08-65.40)
ESR (mm/h)							NA
Median	8.0¹	30.0¹	9	17	4.3¹	14¹
Range	(1.0-57.0)	(5.0-123.0)	(1.0-92.0)	(2.0-41.0)	(2.0-15.0)	(2.0-100.0)
PCT (ng/mL)							NA
Median	0.037	0.043	0.028	0.025	0.028	0.025
Range	(0-4.39)	(0-5.02)	(0-0.082)	(0-0.058)	(0-0.082)	(0-0.058)

¹Identical letters indicate significant differences between the three inactive and active IBD patient groups (Mann-Whitney U-tests, P < 0.001 for all);

²For all indices, IBS patients had significantly lower FC levels than the three groups of active IBD patients (Mann-Whitney U-tests, P < 0.001 for all);

³IBS patients had significantly lower FC levels than the three groups of endoscopic remission IBD patients (Mann-Whitney U-tests, for CICD and CD-related surgery patients, P < 0.001; for UC patients, P < 0.05). CICD: Colonic or ileo-colonic Crohn’s disease; CD: Crohn’s disease; UC: Ulcerative colitis; IBD: Inflammatory bowel disease; IBS: Irritable bowel syndrome; FC: Fecal calprotectin; CDAI/CAI: Clinical activity index; PCT: Procalcitonin; NA: Not applicable.

Table 3 Noninvasive parameters according to endoscopic activity grade in colonic or ileo-colonic Crohn’s disease patients

	Inactive, n₁ = 21		Mild activity, n₂ = 8		Moderate activity, n₃ = 9		Severe activity, n₄ = 18
FC, median (range)	125.7(0-658.7)		717.8 (137.7-1805.0)		1211.8 (660.8-1805.0)		1805.0 (264.6-2266.1)
P value		< 0.05		NS		< 0.05
CDAI, median (range)	63.1 (32.2-155.0)		125.4 (46.8-157.8)		145.1 (75.0-234.9)		201.4 (64.7-364.0)
P value		< 0.05		NS		< 0.05
CRP, median (range)	0.48(0.1-12.9)		5.1 (0.20-48.1)		15.0 (0.6-70.8)		30.6 (1.1-79.8)
P value		NS		NS		< 0.05
ESR, median (range)	8.0(1.0-57.0)		22.0 (5.0-68.0)		28.0 (8.9-95.0)		37.0 (5.5-123.0)
P value		NS		NS		< 0.05
PCT, median (range)	0.037 (0-4.39)		0.038 (0.021-0.064)		0.038 (0-0.137)		0.049 (0.02-5.02)
P value		NS		NS		NS

FC: Fecal calprotectin; CDAI: Clinical activity index; PCT: Procalcitonin; NS: No significant.

Table 4 Noninvasive parameters according to endoscopic activity grade in ulcerative colitis patients

	Inactive, n₁ = 12		Mild activity, n₂ = 12		Moderate activity, n₃ = 16		Severe activity, n₄ = 5
FC, median (range)	45.3 (6.7-189.42)		474.8 (74.9-1805.0)		769.9 (186.8-2266.1)		1704.6 (788.4-2092.4)
P value		< 0.001		NS		< 0.05
CAI, median (range)	1 (0-4)		2.5 (1-8)		6.5 (2-17)		9 (8-15)
P value		< 0.05		< 0.001		NS
CRP, median (range)	0.39 (0.04-2.10)		1.9 (0.26-65.40)		4.7 (0.08-28.19)		16.4 (7.1-53.2)
P value		NS		NS		< 0.05
ESR, median (range)	4.3 (2.0-15.0)		8.5 (2.0-40.0)		14.0 (2.0-88.0)		45.0 (24.0-100.0)
P value		NS		NS		< 0.05
PCT, median (range)	0.03 (0-0.041)		0.031 (0.023-0.127)		0.044 (0.021-0.538)		0.035 (0.026-0.085)
P value		NS		NS		NS

FC: Fecal calprotectin; CAI: Clinical activity index; PCT: Procalcitonin; UC: Ulcerative colitis; NS: No significant.

Table 5 Sensitivity, specificity, positive predictive value, and negative predictive value of fecal calprotectin, CRP, and ESR in predicting endoscopic active disease in inflammatory bowel disease patients in clinical remission

	FC ≥ 250 μg/g	CRP ≥ 5 mg/L	ESR ≥ 10 mm/h
Colonic or ileum-colonic CD (%)
Sensitivity	93	46.2	61.5
Specificity	70	83.3	66.7
PPV	68.4	75.0	53.3
NPV	93.3	73.1	73.7
AUC	0.91	0.76	0.71
P value	< 0.001	0.011	0.042
UC
Sensitivity	84.6	23.1	46.2
Specificity	100	100	83.3
PPV	100	100	75.0
NPV	85.7	54.5	58.8
AUC	0.96	0.84	0.76
P value	< 0.001	0.004	0.028

CD: Crohn’s disease; UC: Ulcerative colitis; FC: Fecal calprotectin; PPV: Positive predictive value; NPV: Negative predictive value; AUC: Area under the ROC curve.

Table 6 Sensitivity, specificity, positive predictive value, and negative predictive value of FC, CDAI/CAI, CRP, ESR, and CAF in predicting endoscopic active disease in three groups of inflammatory bowel disease patients

	FC ≥ 250 μg/g	CDAI > 150/CAI > 4	CRP ≥ 5 mg/L	ESR ≥ 10 mm/h	CFA ≥ 850 or ≥ 150
Colonic or ileum-colonic CD (%)
Sensitivity	97.1	60	71.4	82.8	91.4
Specificity	71.4	95.2	90.5	57.1	90.5
PPV	85	95.5	92.6	76.3	94.1
NPV	93.8	58.8	65.5	66.7	86.4
Accuracy	87.5	73.2	78.6	73.2	91.1
CD-related surgery (%)
Sensitivity	50.0	40.0	50.0	60.0	NA
Specificity	66.7	73.3	73.3	53.3	NA
PPV	50	50.0	55.6	46.2	NA
NPV	66.7	64.7	68.8	66.7	NA
Accuracy	60	60.0	64.0	56.0	NA
UC
Sensitivity	87.9	60.6	42.4	63.6	92.8
Specificity	100	100	100	83.3	91.7
PPV	100	100	100	91.3	96.8
NPV	75.0	48.0	38.7	45.5	78.6
Accuracy	91.1	71.1	57.8	68.89	91.1

CD: Crohn’s disease; UC: Ulcerative colitis; FC: Fecal calprotectin; CDAI/CAI: Clinical activity index; CFA: Clinical FC activity; PPV: Positive predictive value; NPV: Negative predictive value.

Citation: Chen JM, Liu T, Gao S, Tong XD, Deng FH, Nie B. Efficacy of noninvasive evaluations in monitoring inflammatory bowel disease activity: A prospective study in China. World J Gastroenterol 2017; 23(46): 8235-8247
URL: https://www.wjgnet.com/1007-9327/full/v23/i46/8235.htm
DOI: https://dx.doi.org/10.3748/wjg.v23.i46.8235