Abstract
Background and Aims
Evaluating disease activity is important in ulcerative colitis. Laboratory markers should be a non-invasive alternative to endoscopy for patients. The objective of our study was to scrutinize the correlation between C-reactive protein (CRP) levels and clinical and endoscopic activity in ulcerative colitis patients.
Materials and Methods
We conducted a prospective study between January 2007 and December 2009. In the study we chose consecutive patients of our department with ulcerative colitis. All patients received a standardized questionnaire, clinical examination, and colonoscopy. Based on clinical and endoscopic data, we calculated the disease activity index (DAI) and the Rachmilewitz score.
Results
One-hundred and one patients were included. At the time of inclusion, 67 patients had an active disease and 34 patients were in remission. The mean DAI was 6.9 (1–12). The mean Rachmilewitz score was 4.7 (0–12). The median CRP rate was 20.2 ± 24.5 mg/l (1–107 mg/l). An increased CRP was found in 46 patients (46%). An increased CRP level was observed in patients with active disease (P < 0.0001). The DAI was higher in patients with increased CRP (9.5 ± 1.6 vs. 4.7 ± 3.6; P < 0.0001). The Rachmilewitz score was also higher in patients with increased CRP (7.2 ± 2.3 vs. 2.7 ± 3.2; P < 0.0001). A statistically significant association was found between the CRP and the DAI (r = 0.51, P < 0.0001) and between the CRP and the Rachmilewitz score (r = 0.46, P < 0.0001). The optimum cut-off of CRP level that separates active or inactive disease was calculated to be 10 ml/l, with AUC estimated at 0.81 ± 0.04 (95%CI: 0.72–0.88), a sensitivity of 67.1 (95%CI: 54.6–78.1) and a specificity of 97% (95%CI: 84.6–99.5).
Conclusion
Levels of CRP are correlated to clinical and endoscopic activity in ulcerative colitis patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Stange EF, Travis SPL, Vermeire S, et al. European evidence-based consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis. J Crohn Colitis. 2008;2:1–23.
Naber AHJ, De Jong DJ. Assessment of disease activity in inflammatory bowel disease: Relevance for clinical trials. Neth J Med. 2003;61:105–110.
Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in inflammatory bowel disease: Useful, magic or unnecessary tools? Gut. 2006;55:426–431.
Karoui S, Serghini M, Boubaker J, Filali A. C-reactive protein: A useful tool for evaluation of clinical activity in inflammatory bowel disease? In Nagasawa S (ed) C-reactive protein: new research. Nova Science Publisher, New York. 2009:43–49.
Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomised study. N Engl J Med. 1987;317:1625–1629.
Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. Br Med J. 1989;298:82–86.
Silverberg MS, Satsangi J, Ahmad T et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal world congress of gastroenterlogy. Can J Gastroenterol. 2005;19:5A–36A.
Mehdi A, Baccouche A, Skandrani K, et al. Epidémiologie des maladies inflammatoires chroniques de l’intestin dans le centre-est tunisien. Maghreb Médical. 1997;314:47–52.
Crama-Bohbouth G, Pena AS, Biemond I, et al. Are activity indices useful in assessing active intestinal inflammation in Crohn’s disease? Gut. 1989;30:1236–1240.
Tall AR. C-reactive protein reassessed. N Engl J Med. 2004;350:1450–1452.
Vermeire S, Van Assche G, Rutgeerts P. C-reactive protein as a marker for inflammatory bowel disease. Inflamm Bowel Dis. 2004;10:661–665.
Karoui S, Ouerdiane S, Serghini M, et al. Correlation between levels of C-reactive protein and clinical activity in Crohn’s disease. Dig Liver Dis. 2007;39:1006–1010.
Solem CA, Loftus EV Jr, Tremaine WJ, et al. Correlation of C-reactive protein with clinical, endoscopic, histologic and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis. 2005;11:707–712.
Schoepfer AM, Beglinger C, Straumann A, Trummler M, Renzulli P, Seibold F. Ulcerative colitis: Correlation of the Rachmilewitz endoscopic activity index with fecal calprotectin, clinical activity, C-reactive protein, and blood leukocytes. Inflamm Bowel Dis. 2009;15:1851–1858.
Osada T, Ohkusa T, Okayasu I, et al. Correlations among total colonoscopic findings, clinical symptoms, and laboratory markers in ulcerative colitis. J Gastroenterol Hepatol. 2008;23(2):S262–S267.
Henriksen M, Jahnsen J, Lygren I, et al. C-reactive protein: A predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study. Gut. 2008;57:1518–1523.
Langhorst J, Elsenbruch S, Koelzer J, Rueffer A, Michalsen A, Dobos GJ. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2008;103:162–169.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Karoui, S., Laz, S., Serghini, M. et al. Correlation of C-Reactive Protein with Clinical and Endoscopic Activity in Patients with Ulcerative Colitis. Dig Dis Sci 56, 1801–1805 (2011). https://doi.org/10.1007/s10620-010-1496-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-010-1496-7