Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn's disease after surgery

Wright, Emily K., Kamm, Michael A., De Cruz, Peter, Hamilton, Amy L., Ritchie, Kathryn J., Krejany, Efrosinia O., Leach, Steven, Gorelik, Alexandra, Liew, Danny, Prideaux, Lani, Lawrance, Ian C., Andrews, Jane M., Bampton, Peter A., Jakobovits, Simon L., Florin, Timothy H., Gibson, Peter R., Debinski, Henry, Macrae, Finlay A., Samuel, Douglas, Kronborg, Ian, Radford-Smith, Graeme, Selby, Warwick, Johnston, Michael J., Woods, Rodney, Elliott, P. Ross, Bell, Sally J., Brown, Steven J., Connell, William R., Day, Andrew S., Desmond, Paul V. and Gearry, Richard B. (2015) Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn's disease after surgery. Gastroenterology, 148 5: 938-947. doi:10.1053/j.gastro.2015.01.026

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Author Wright, Emily K.
Kamm, Michael A.
De Cruz, Peter
Hamilton, Amy L.
Ritchie, Kathryn J.
Krejany, Efrosinia O.
Leach, Steven
Gorelik, Alexandra
Liew, Danny
Prideaux, Lani
Lawrance, Ian C.
Andrews, Jane M.
Bampton, Peter A.
Jakobovits, Simon L.
Florin, Timothy H.
Gibson, Peter R.
Debinski, Henry
Macrae, Finlay A.
Samuel, Douglas
Kronborg, Ian
Radford-Smith, Graeme
Selby, Warwick
Johnston, Michael J.
Woods, Rodney
Elliott, P. Ross
Bell, Sally J.
Brown, Steven J.
Connell, William R.
Day, Andrew S.
Desmond, Paul V.
Gearry, Richard B.
Title Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn's disease after surgery
Journal name Gastroenterology   Check publisher's open access policy
ISSN 1528-0012
0016-5085
Publication date 2015-05-01
Sub-type Article (original research)
DOI 10.1053/j.gastro.2015.01.026
Open Access Status File (Author Post-print)
Volume 148
Issue 5
Start page 938
End page 947
Total pages 10
Place of publication Maryland Heights, MO United States
Publisher W. B. Saunders
Language eng
Subject 2715 Gastroenterology
Abstract Background & Aims Crohn's disease (CD) usually recurs after intestinal resection; postoperative endoscopic monitoring and tailored treatment can reduce the chance of recurrence. We investigated whether monitoring levels of fecal calprotectin (FC) can substitute for endoscopic analysis of the mucosa. Methods We analyzed data collected from 135 participants in a prospective, randomized, controlled trial, performed at 17 hospitals in Australia and 1 hospital in New Zealand, that assessed the ability of endoscopic evaluations and step-up treatment to prevent CD recurrence after surgery. Levels of FC, serum levels of C-reactive protein (CRP), and Crohn's disease activity index (CDAI) scores were measured before surgery and then at 6, 12, and 18 months after resection of all macroscopic Crohn's disease. Ileocolonoscopies were performed at 6 months after surgery in 90 patients and at 18 months after surgery in all patients. Results Levels of FC were measured in 319 samples from 135 patients. The median FC level decreased from 1347 μg/g before surgery to 166 μg/g at 6 months after surgery, but was higher in patients with disease recurrence (based on endoscopic analysis; Rutgeerts score, ≥i2) than in patients in remission (275 vs 72 μg/g, respectively; P <.001). Combined 6- and 18-month levels of FC correlated with the presence (r = 0.42; P <.001) and severity (r = 0.44; P <.001) of CD recurrence, but the CRP level and CDAI score did not. Levels of FC greater than 100 μg/g indicated endoscopic recurrence with 89% sensitivity and 58% specificity, and a negative predictive value (NPV) of 91%; this means that colonoscopy could have been avoided in 47% of patients. Six months after surgery, FC levels less than 51 μg/g in patients in endoscopic remission predicted maintenance of remission (NPV, 79%). In patients with endoscopic recurrence at 6 months who stepped-up treatment, FC levels decreased from 324 μg/g at 6 months to 180 μg/g at 12 months and 109 μg/g at 18 months. Conclusions In this analysis of data from a prospective clinical trial, FC measurement has sufficient sensitivity and NPV values to monitor for CD recurrence after intestinal resection. Its predictive value might be used to identify patients most likely to relapse. After treatment for recurrence, the FC level can be used to monitor response to treatment. It predicts which patients will have disease recurrence with greater accuracy than CRP level or CDAI score.
Formatted abstract
Background & aims:  Crohn’s disease (CD) usually recurs after intestinal resection; postoperative endoscopic monitoring and tailored treatment can reduce the chance of recurrence. We investigated whether monitoring levels of fecal calprotectin (FC) can substitute for endoscopic analysis of the mucosa.

Methods:  We analyzed data collected from 135 participants in a prospective, randomized, controlled trial, performed at 17 hospitals in Australia and 1 hospital in New Zealand, that assessed the ability of endoscopic evaluations and step-up treatment to prevent CD recurrence after surgery. Levels of FC, serum levels of C-reactive protein (CRP), and Crohn’s disease activity index (CDAI) scores were measured before surgery and then at 6, 12, and 18 months after resection of all macroscopic Crohn’s disease. Ileocolonoscopies were performed at 6 months after surgery in 90 patients and at 18 months after surgery in all patients.

Results:  Levels of FC were measured in 319 samples from 135 patients. The median FC level decreased from 1347 μg/g before surgery to 166 μg/g at 6 months after surgery, but was higher in patients with disease recurrence (based on endoscopic analysis; Rutgeerts score, ≥i2) than in patients in remission (275 vs 72 μg/g, respectively; P < .001). Combined 6- and 18-month levels of FC correlated with the presence (r = 0.42; P < .001) and severity (r = 0.44; P < .001) of CD recurrence, but the CRP level and CDAI score did not. Levels of FC greater than 100 μg/g indicated endoscopic recurrence with 89% sensitivity and 58% specificity, and a negative predictive value (NPV) of 91%; this means that colonoscopy could have been avoided in 47% of patients. Six months after surgery, FC levels less than 51 μg/g in patients in endoscopic remission predicted maintenance of remission (NPV, 79%). In patients with endoscopic recurrence at 6 months who stepped-up treatment, FC levels decreased from 324 μg/g at 6 months to 180 μg/g at 12 months and 109 μg/g at 18 months.

Conclusions:
 In this analysis of data from a prospective clinical trial, FC measurement has sufficient sensitivity and NPV values to monitor for CD recurrence after intestinal resection. Its predictive value might be used to identify patients most likely to relapse. After treatment for recurrence, the FC level can be used to monitor response to treatment. It predicts which patients will have disease recurrence with greater accuracy than CRP level or CDAI score.
Keyword Inflammatory bowel disease
Fecal biomarkers
Prognostic factor
Prognosis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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