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Fecal calprotectin performs best for diagnosing children with IBD symptoms
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Among common laboratory markers used in the diagnostic workup of children with symptoms of inflammatory bowel disease in hospital settings, fecal calprotectin improved diagnostic accuracy the most, and reduced the number of patients for whom clinical decision making is most difficult, according to the results of a meta-analysis.
All blood markers also individually improved the diagnosis of pediatric IBD when added to the evaluation of signs and symptoms, investigators noted.
“To make a definitive diagnosis of IBD, endoscopy is needed. This is an invasive, unpleasant and potentially harmful procedure,” Marjolein Y. Berger, PhD, of the department of general practice at University Medical Center Groningen in the Netherlands, told Healio Gastroenterology. “In children in whom a pediatrician is in doubt whether to perform endoscopy or not, fecal calprotectin, added to a careful history and physical exam, reduces this uncertainty.”
To determine whether lab markers improved diagnostic accuracy when added to the evaluation of pediatric IBD symptoms, Berger and colleagues performed a systematic review and meta-analysis of individual patient data. They reviewed relevant literature published through September 2016, identified 16 eligible studies, and requested individual patient data from the study authors. Ultimately, they received data sets from eight of the eligible studies (n = 1,120), and evaluated how well each marker improved discrimination and risk classification.
While all markers and fecal calprotectin each significantly improved the ability to discriminate between patients with (n = 560) and without IBD when added to symptom evaluation, fecal calprotectin performed the best. The differences that adding each lab marker made to the area under the curve values of a basic prediction model based on symptoms were:
- 0.26 (95% CI, 0.21-0.31) for fecal calprotectin;
- 0.16 (95% CI, 0.11-0.21) for erythrocyte sedimentation rate;
- 0.13 (95% CI, 0.08-0.19) for platelets;
- 0.13 (95% CI, 0.08-0.19) for hemoglobin;
- 0.13 (95% CI, 0.05-0.21) for albumin; and
- 0.08 (95% CI, 0.04-0.11) for C-reactive protein.
When the researchers added fecal calprotectin to the basic model of symptoms, the percentage of patients without IBD who were correctly classified as having a low risk for IBD increased from 33% to 91%, while the percentage of patients with IBD who were incorrectly classified as having a low risk for IBD dropped from 16% to 9%, and the percentage of patients classified as having an intermediate-risk for IBD dropped from 55% to 6%.
The investigators concluded that “fecal calprotectin should be recommended for the triage of pediatric patients with symptoms suggestive of inflammatory bowel disease.”
“This study gives firm evidence for the diagnostic value of fecal calprotectin in the diagnostic work-up for IBD,” Berger said. “However, before implementing a diagnostic pathway in which fecal calprotectin will be used to prevent endoscopy in children, suspected of IBD a clinical impact study is needed.” – by Adam Leitenberger
Disclosures: Berger reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
Editor's note: This article was updated on August 16 with comments from a study investigator.
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