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Fecal calprotectin and its correlation with inflammatory markers and endoscopy in patients from India with inflammatory bowel disease

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Abstract

Introduction

In clinical practice, endoscopic findings are often used for assessing disease activity in inflammatory bowel disease (IBD). In recent years, blood and stool markers are being increasingly used for this purpose. Among them, the fecal calprotectin (FC) level is probably the most favored. Data on the reliability of FC are lacking from countries like India, where gut infections are common.

Objective

The aims of this study were to compare the FC level with the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) as non-invasive markers of IBD and, in patients with ulcerative colitis (UC), and to study its correlation with disease extent, clinical activity, and endoscopic severity.

Methods

Records of patients with IBD who had tests for FC, ESR and CRP and colonoscopy done within a 2-week period, between 2012 and 2014, were retrieved. Sixty-three patients (UC 32, Crohn’s disease [CD] 31) were included for analysis. ESR, CRP and FC were compared to endoscopy to assess inflammation.

Results

Patients with UC had higher levels of FC than those with ileocolonic CD (median FC 800 mcg/g vs. 619 mcg/g, respectively; p = 0.04). FC levels correlated with CRP (r = 0.4, p < 0.001) but not with ESR (r = 0.21, p = 0.09). In patients with UC with endoscopic evidence of inflammation, more (86.9 %) had FC >200 mcg/g (cut-off for disease activity in our laboratory) than had ESR >20 mm in the first hour (60.6 %) or positive CRP (65.6 %) (<0.01); FC levels increased with increasing endoscopic Mayo score (p = 0.001) and Truelove-Witt’s clinical severity score (p = 0.006), but did not correlate with disease extent (p = 0.7). The best FC cut-off level to identify ‘active UC’ (Mayo grade 2 or more) was 800 mcg/g.

Conclusion

Fecal calprotectin level correlates with CRP but not with ESR. In patients with UC with inflammation, FC >200 mcg/g is more often positive than raised ESR or CRP; it also correlates with clinical and endoscopic activity but not with disease extent. FC level >800 mcg/g can be used to differentiate active from inactive UC.

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Authors and Affiliations

  1. Division of Gastroenterology, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India

    Hrishikesh Samant, Devendra Desai, Philip Abraham, Anand Joshi & Tarun Gupta

  2. Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India

    Alpa Dherai & Tester Ashavaid

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  1. Hrishikesh Samant
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  2. Devendra Desai
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  3. Philip Abraham
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  4. Anand Joshi
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Correspondence to Hrishikesh Samant.

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HS, DD, PA, AJ, TG, AD, and TA declare that they have no conflict of interest.

Ethics statement

Approval for the analysis was obtained from the institution’s review board (P. D. Hinduja National Hospital and Medical Research Centre).The authors declare that the study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning Informed Consent as shown on Springer.com.

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Samant, H., Desai, D., Abraham, P. et al. Fecal calprotectin and its correlation with inflammatory markers and endoscopy in patients from India with inflammatory bowel disease. Indian J Gastroenterol 34, 431–435 (2015). https://doi.org/10.1007/s12664-015-0608-x

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  • DOI: https://doi.org/10.1007/s12664-015-0608-x

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