title: Noninvasive measurement of fecal calprotectin and serum amyloid A combined with intestinal fatty acid-binding protein in necrotizing enterocolitis.
abstract: BACKGROUND
  Diagnosis of necrotizing enterocolitis (NEC), prevalent in premature infants, remains challenging. Enterocyte damage in NEC can be assessed by intestinal fatty acid-binding protein (I-FABP), with a sensitivity of 93% and a specificity of 90%. Numerous markers of inflammation are known, such as serum amyloid A (SAA) and fecal calprotectin.
  
  
  OBJECTIVE
  The aim of the present study was to evaluate which combination of noninvasive measurement of inflammatory markers and I-FABP improves the diagnostic accuracy in neonates suspected for NEC.
  
  
  METHODS
  In 62 neonates with clinical suspicion of NEC (29 with final diagnosis of NEC), urinary I-FABP, urinary SAA, and fecal calprotectin levels were determined quantitatively. Diagnostic accuracy was calculated for the combinations I-FABP-SAA and I-FABP-fecal calprotectin, using a multivariable logistic regression model.
  
  
  RESULTS
  The combination of SAA and I-FABP did not increase the diagnostic accuracy of I-FABP. However, the combination of fecal calprotectin and I-FABP improved accuracy significantly. The combination of urinary I-FABP and fecal calprotectin measurement produced a sensitivity of 94%, a specificity of 79%, a positive likelihood ratio of 4.48, and a negative likelihood ratio of 0.08.
  
  
  CONCLUSIONS
  The combination of noninvasive measurement of I-FABP and fecal calprotectin seems promising for diagnosing NEC at an early time point. Prospective analysis is required to confirm this finding and to evaluate better treatment strategies based on noninvasive measurement of I-FABP and calprotectin.
authors.affiliation: Department of Surgery, Maastricht University Medical Center, and Nutrition and Toxicology Research Institute, 6200 MD, Maastricht, The Netherlands. k.reisinger@maastrichtuniversity.nl
authors.forename: Kostan W
authors.initials: KW
authors.lastname: Reisinger
authors.forename: David C
authors.initials: DC
authors.lastname: Van der Zee
authors.forename: Hens A A
authors.initials: HA
authors.lastname: Brouwers
authors.forename: Boris W
authors.initials: BW
authors.lastname: Kramer
authors.forename: L W Ernest
authors.initials: LW
authors.lastname: van Heurn
authors.forename: Wim A
authors.initials: WA
authors.lastname: Buurman
authors.forename: Joep P M
authors.initials: JP
authors.lastname: Derikx
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000378:metabolism; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000685:Serum Amyloid A Protein / Q000652:urine*
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D039841:Leukocyte L1 Antigen Complex; D000685:Serum Amyloid A Protein