title: Fecal calprotectin and lactoferrin for the prediction of inflammatory bowel disease relapse.
abstract: BACKGROUND
  The purpose of the study was to determine the role of fecal calprotectin and lactoferrin in the prediction of inflammatory bowel disease relapses, both in patients with ulcerative colitis (UC) and Crohn's disease (CD), in a large, long-term, follow-up study.
  
  
  METHODS
  The prospective multicenter study included CD and UC patients who had been in clinical remission for 6 months. At baseline, patients provided a single stool sample for calprotectin and lactoferrin determination. Follow-up was 12 months in patients showing no relapse and until activity flare in relapsing patients.
  
  
  RESULTS
  In all, 163 patients (89 CD, 74 UC) were included. Twenty-six patients (16%) relapsed during follow-up. Calprotectin concentrations in patients who suffered a relapse were higher than in nonrelapsing patients (239 +/- 150 versus 136 +/- 158 microg/g; P < 0.001). Relapse risk was higher in patients having high (>150 microg/g) calprotectin concentrations (30% versus 7.8%; P < 0.001) or positive lactoferrin (25% versus 10%; P < 0.05). Fecal calprotectin (>150 microg/g) sensitivity and specificity to predict relapse were 69% and 69%, respectively. Corresponding values for lactoferrin were 62% and 65%, respectively. The area under the receiver operating characteristic curve to predict relapse using calprotectin determination was 0.73 (0.69 for UC and 0.77 for CD). Better results were obtained when only colonic CD disease or only relapses during the first 3 months were considered (100% sensitivity). High fecal calprotectin levels or lactoferrin positivity was associated with clinical relapse in Kaplan-Meier survival analysis, and both fecal tests were associated with relapse in the multivariate analysis.
  
  
  CONCLUSIONS
  Fecal calprotectin and lactoferrin determination may be useful in predicting impending clinical relapse-especially during the following 3 months-in both CD and UC patients.
authors.affiliation: Gastroenterology Unit, Hospital Universitario de la Princesa and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. gisbert@meditex.es
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: Fernando
authors.initials: F
authors.lastname: Bermejo
authors.forename: Jose-Lázaro
authors.initials: JL
authors.lastname: Pérez-Calle
authors.forename: Carlos
authors.initials: C
authors.lastname: Taxonera
authors.forename: Isabel
authors.initials: I
authors.lastname: Vera
authors.forename: Adrian G
authors.initials: AG
authors.lastname: McNicholl
authors.forename: Alicia
authors.initials: A
authors.lastname: Algaba
authors.forename: Pilar
authors.initials: P
authors.lastname: López
authors.forename: Natalia
authors.initials: N
authors.lastname: López-Palacios
authors.forename: Marta
authors.initials: M
authors.lastname: Calvo
authors.forename: Yago
authors.initials: Y
authors.lastname: González-Lama
authors.forename: Jose-Antonio
authors.initials: JA
authors.lastname: Carneros
authors.forename: Marta
authors.initials: M
authors.lastname: Velasco
authors.forename: José
authors.initials: J
authors.lastname: Maté
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000378:metabolism; D003424:Crohn Disease / Q000175:diagnosis* / Q000378:metabolism; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007781:Lactoferrin / Q000032:analysis*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D007781:Lactoferrin