Fecal Calprotectin At The Time Of Diagnosis May Indicate The Presence Of Complications In Inflammatory Bowel Disease

Abstract

Aim: We aimed to investigate the relationship between the presence of complications at the time of diagnosis or during follow-up and fecal calprotectin in patients with inflammatory bowel disease. Materials and Methods: Fecal calprotectin level was studied by the chromatographic lateral flow immunoassay method. Results: A total of 76 patients, 26 (34%) with Crohn's disease and 50 (66%) with ulcerative colitis, were included in the study. At the time of diagnosis and during follow-up, complications were observed in 17 (22%) and 20 (26%) patients, respectively. At the time of diagnosis, fecal calprotectin level was low (<50 mg/kg) in 26 (34%) patients, borderline (50-100 mg/kg) in 16 (21%) patients, and high (>100 mg/kg) in 34 (45%) patients. Hemoglobin and albumin levels were lower (p=0.013, p=0.012, respectively), and platelet count, eryrocyte sedimentation rate, and C-reactive protein levels were higher (p<0.001, p=0.004, p<0.001, respectively) in patients with high fecal calprotectin level than patients with low fecal calprotectin level. At the time of diagnosis and during follow-up, complications were higher in patients with high fecal calprotectin level than patients with low and borderline fecal calprotectin levels (p=0.001). The risk of developing complications was found to be 26 times higher at the time of diagnosis in patients with fecal calprotectin level >100 µg/g than patients with fecal calprotectin level below this value and 8 times higher during follow-up (p=0.006, p=0.015, respectively). Conclusion: The use of fecal calprotectin level together with tests showing acute inflammation in inflammatory bowel disease may predict the development of complications.

Keywords

• Fecal calprotectin
• inflammatory bowel disease
• complications
• acute phase reactants

İnflamatuvar Bağırsak Hastalığında Tanı Anındaki Fekal Kalprotektin Komplikasyon Varlığını Gösterebilir

Abstract

Amaç: İnflamatuvar bağırsak hastalığı olan hastalarda tanı anında ya da takip esnasındaki komplikasyon varlığı ile fekal kalprotektin arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Fekal kalprotektin düzeyi, kromatografik lateral akım immünoassay metodu ile çalışıldı Bulgular: Çalışmaya 26’sı (%34) Crohn’s hastalığı ve 50’si (%66) ülseratif kolit olan toplam 76 hasta alındı. Tanı anı ve takip sırasında hastaların sırasıyla 17 (%22) ve 20’sinde (%26) komplikasyon gözlendi. Tanı anında fekal kalprotektin düzeyi 26 (%34) hastada düşük (<50 mg/kg), 16 (%21) hastada sınırda (50-100 mg/kg) ve 34 (%45) hastada yüksek (>100 mg/kg) idi. Fekal kalprotektin düzeyi yüksek olan hastalarda düşük olan hastalara göre hemoglobin ve albümin düzeyleri daha düşük (sırasıyla, p=0.013, p=0.012), trombosit, eritrosit sedimentasyon hızı ve C-reaktif protein düzeyleri daha yüksekti (sırasıyla, p<0.001, p=0.004, p<0.001). Hastaların tanı anı ve takipleri sırasında komplikasyon varlığı fekal kalprotektin düzeyi yüksek olanlarda, düşük ve sınırda olanlara göre daha yüksek oranda olduğu gözlendi (p=0.001). Fekal kalprotektin düzeyi >100 mg/kg olan hastalarda bu değerin altında olan hastalara göre tanı anında komplikasyon gelişme riskinin 26 kat, takip esnasında ise 8 kat daha yüksek olduğu tespit edildi (sırasıyla, p=0.006, p=0.015). Sonuç: İnflamatuvar bağırsak hastalığında akut inflamasyonu gösteren tetkiklerle birlikte fekal kalprotektin düzeyinin kullanılması komplikasyon gelişimini öngörebilir.

Keywords

• Fekal kalprotektin
• inflamatuvar bağırsak hastalığı
• komplikasyonlar
• akut faz reaktanları

References

1. 1. Flynn S, Eisenstein S. Inflammatory bowel disease presentation and diagnosis. Surg Clin North Am 2019;99:1051-62.
2. 2. Goldstone RN , Steinhagen RM. Abdominal emergencies in inflammatory bowel disease. Surg Clin North Am 2019;99:1141-50.
3. 3. Ricciuto A, Griffiths AM. Clinical value of fecal calprotectin. Crit Rev Clin Lab Sci 2019;56:307-20.
4. 4. Romberg-Camps MJL, Dagnelie PC, Kester ADM, et al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol 2009;104:371-83.
5. 5. Sipponen T, Kolho KL. Fecal calprotectin in diagnosis and clinical assessment of inflammatory bowel disease. Scand J Gastroenterol 2015;50:74-80.
6. 6. Manceau H, Chicha-Cattoir V, Puy H, Peoc’h K. Fecal calprotectin in inflammatory bowel diseases: update and perspectives. Clin Chem Lab Med 2017;55:474-83.
7. 7. Waugh N, Cummins E, Royle P, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Health Technol Assess 2013;17:1-211.
8. 8. Theede K, Holck S, Ibsen P, Ladelund S, Nordgaard-Lassen I, Nielsen AM. Level of fecal calprotectin correlates with endoscopic and histologic inflammation and identifies patients with mucosal healing in ulcerative colitis. Clin Gastroenterol Hepatol 2015;13:1929-36.

9. 9. Siegel CA, Bernstein CN. Identifying patients with inflammatory bowel diseases at high vs low risk of complications. Clin Gastroenterol Hepatol 2020;18:1261-7.
10. 10. Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn’s disease. Dis Mon 2018;64:20-57.
11. 11. Sehgal R, Koltun WA. Scoring system in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 2010;4:513-21.
12. 12. Pabla BS, Schwartz DA. Assessing severity of disease in patients with ulcerative colitis. Gastroenterol Clin North Am 2020;49:671-88.
13. 13. Molander P, Sipponen T, Kemppainen H, et al. Achievement of deep remission during scheduled maintenance therapy with TNFα-blocking agents in IBD. J Crohns Colitis 2013;7:730-5.
14. 14. Fabian O, Hradsky O, Lerchova T, Mikus F, Zamecnik J, Bronsky J. Limited clinical significance of tissue calprotectin levels in bowel mucosa for the prediction of complicated course of the disease in children with ulcerative colitis. Pathol Res Pract 2019;215:152689.
15. 15. Bodelier AGL, Jonkers D, van den Heuvel TV, et al. High percentage of IBD patients with indefinite fecal calprotectin levels: Additional value of a combination score. Dig Dis Sci 2017;62:465-72.
16. 16. Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut 2006;55:426-31.
17. 17. Solem CA, Loftus Jr EV, Tremaine WJ, Harmsen WS, Zinsmeister AR, Sandborn WJ. Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis 2005;11:707-12.
18. 18. Kwon JH, Im JP, Ye BD, et al. Disease phenotype, activity and clinical course prediction based on C-reactive protein levels at diagnosis in patients with Crohn’s disease:results from the CONNECT study. Gut Liver 2016;10:595-603.
19. 19. Ricanek P, Brackmann S, Perminow G, et al. Evaluation of disease activity in IBD at the time of diagnosis by the use of clinical, biochemical, and fecal markers. Scand J Gastroenterol 2011;46:1081-91.
20. 20. Abej E, El-Matary W, Singh H, Bernstein CN. The utility of fecal calprotectin in the real-world clinical care of patients with inflammatory bowel disease. Can J Gastroenterol Hepatol 2016;2016:2483261.
21. 21. Bergamaschi G, Sabatino AD, Corazza GR. Pathogenesis, diagnosis and treatment of anaemia in immune-mediated gastrointestinal disorders. Br JHaematol 2018;182:319-29.