Fecal calprotectin and lactoferrin for the prediction of inflammatory bowel disease relapse.
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.
Gisbert
Javier P
JP
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
Bermejo
Fernando
F
Pérez-Calle
Jose-Lázaro
JL
Taxonera
Carlos
C
Vera
Isabel
I
McNicholl
Adrian G
AG
Algaba
Alicia
A
López
Pilar
P
López-Palacios
Natalia
N
Calvo
Marta
M
González-Lama
Yago
Y
Carneros
Jose-Antonio
JA
Velasco
Marta
M
Maté
José
J
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
D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D007781:Lactoferrin