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Elevated fecal calprotectin predicts Crohn’s progression
Routinely measuring levels of fecal calprotectin can identify patients at risk for Crohn’s disease progression regardless of symptoms, according to study results published in Clinical Gastroenterology and Hepatology.
Nicholas A. Kennedy, MBBS, MA, Cantab , FRACP, of the Exeter IBD Group in the United Kingdom, and colleagues wrote that management of CD has shifted to a focus on mucosal healing, which requires endoscopic surveillance. Researchers wanted to find out if fecal calprotectin could be used as a biomarker for mucosal healing.
“The use of [fecal calprotectin] as a prognostic marker has been demonstrated in the context of medically- and surgically-induced remission,” Kennedy and colleagues wrote. “However, it has still not yet been demonstrated whether elevations in [fecal calprotectin], irrespective of clinical symptoms, are associated with disease progression. This information would provide further support to the principle of treating beyond symptoms.”
Investigators explored calprotectin’s role in disease progression in a retrospective study of 918 patients with CD managed at a tertiary medical center in Edinburgh, U.K., from 2003 to 2015. They included patients that had at least one fecal calprotectin measurement made at least three months after their diagnosis. They used clinical data to identify factors associated with a composite outcome of progression in Montreal behavior, hospitalization and resection.
Investigators found that the median level of fecal calprotectin at the index visit was 432 µg/g (IQR, 1365–998 µg/g) in patients who reached the composite endpoint compared with 180 µg/g (IQR, 50–665 µg/g) in patients who did not, indicating that elevated fecal calprotectin was associated with late progression of CD.
In their analysis, researchers determined that a fecal calprotectin cutoff of 115 µg/g identified patients who met the endpoint (HR = 2.4; 95% CI, 1.8–3.1).
Kennedy and colleagues wrote their findings show that calprotectin can be used as a marker of increased risk for disease progression in CD.
“Elevated fecal calprotectin is associated with an increased risk of disease progression over time in Crohn’s disease,” they concluded. “Further studies should continue to explore the utility of repeated [fecal calprotectin] measurements, and to assess whether intervention based on [fecal calprotectin] can alter disease outcome.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.