title: C-Reactive Protein, Fecal Calprotectin, and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Persistent disease activity is associated with a poor prognosis in inflammatory bowel disease (IBD). Therefore, monitoring of patients with intent to suppress subclinical inflammation has emerged as a treatment concept. As endoscopic monitoring is invasive and resource intensive, identification of valid markers of disease activity is a priority. The objective was to evaluate the diagnostic accuracy of C-reactive protein (CRP), fecal calprotectin (FC), and stool lactoferrin (SL) for assessment of endoscopically defined disease activity in IBD.
  
  
  METHODS
  Databases were searched from inception to November 6, 2014 for relevant cohort and case-control studies that evaluated the diagnostic accuracy of CRP, FC, or SL and used endoscopy as a gold standard in patients with symptoms consistent with active IBD. Sensitivities and specificities were pooled to generate operating property estimates for each test using a bivariate diagnostic meta-analysis.
  
  
  RESULTS
  Nineteen studies (n=2499 patients) were eligible. The pooled sensitivity and specificity estimates for CRP, FC, and SL were 0.49 (95% confidence interval (CI) 0.34-0.64) and 0.92 (95% CI 0.72-0.96), 0.88 (95% CI 0.84-0.90) and 0.73 (95% CI 0.66-0.79), and 0.82 (95% CI 0.73-0.88) and 0.79 (95% CI 0.62-0.89), respectively. FC was more sensitive than CRP in both diseases and was more sensitive in ulcerative colitis than Crohn's disease.
  
  
  CONCLUSIONS
  Although CRP, FC, and SL are useful biomarkers, their value in managing individual patients must be considered in specific clinical contexts.
authors.affiliation: 1] Department of Medicine, University of Western Ontario, London, Ontario, Canada [2] Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia [3] Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
authors.forename: Mahmoud H
authors.initials: MH
authors.lastname: Mosli
authors.affiliation: 1] Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada [2] Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.
authors.forename: Guangyong
authors.initials: G
authors.lastname: Zou
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Garg
authors.affiliation: Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
authors.forename: Sean G
authors.initials: SG
authors.lastname: Feagan
authors.affiliation: Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
authors.forename: John K
authors.initials: JK
authors.lastname: MacDonald
authors.affiliation: 1] Department of Medicine, University of Western Ontario, London, Ontario, Canada [2] London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Chande
authors.affiliation: 1] Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada [2] Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
authors.affiliation: 1] Department of Medicine, University of Western Ontario, London, Ontario, Canada [2] Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada [3] Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Feagan
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D003424:Crohn Disease / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000737:chemistry*; D006801:Humans; D007781:Lactoferrin / Q000378:metabolism*; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein; D007781:Lactoferrin