title: Level of Fecal Calprotectin Correlates With Endoscopic and Histologic Inflammation and Identifies Patients With Mucosal Healing in Ulcerative Colitis.
abstract: OBJECTIVE
  In patients with ulcerative colitis (UC), mucosal healing is an important goal of treatment. However, mucosal healing is difficult to determine on the basis of clinical evaluation alone, and endoscopy is uncomfortable and can cause complications. Fecal calprotectin (FC) is a marker of inflammation, and its levels have been associated with disease activity. We investigated the association between level of FC and mucosal healing and clinical disease activity in patients with UC.
  
  
  METHODS
  We performed an observational cross-sectional study of 120 patients with active or inactive UC who underwent sigmoidoscopy at Copenhagen University Hospital Hvidovre from September 2012 through 2014. Endoscopic inflammation was evaluated by using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and histologic inflammatory activity by a slightly modified Harpaz Index, which measures acute inflammation. The Partial Mayo Score was used to measure the clinical disease activity.
  
  
  RESULTS
  A cutoff level of FC of 192 mg/kg identified patients with endoscopic evidence of mucosal healing, which was based on the MES and UCEIS, with positive predictive values of 0.71 and 0.65, respectively; negative predictive values were 0.90 and 0.93, respectively. A cutoff level of 171 mg/kg identified patients with histologic evidence of mucosal healing, with positive predictive value of 0.75 and negative predictive value of 0.90. Levels of FC increased significantly with increases in endoscopic and histologic disease activity. There was high concordance between MES and UCEIS as well as between MES or UCEIS and histologic inflammatory activity. The histologic activity index had an interobserver variation of 4.35%.
  
  
  CONCLUSIONS
  Level of FC identifies patients with UC who have endoscopic and histologic features of mucosal healing and correlates with endoscopic and histologic inflammatory activity. The UCEIS seems to be as accurate as the MES in identifying patients with mucosal healing and as easy to use. The histologic activity index had a high concordance with recognized endoscopic score systems.
authors.affiliation: Gastrounit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark. Electronic address: klaus.theede@regionh.dk.
authors.forename: Klaus
authors.initials: K
authors.lastname: Theede
authors.affiliation: Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Holck
authors.affiliation: Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Ibsen
authors.affiliation: Clinical Research Center, Department of Statistics, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Steen
authors.initials: S
authors.lastname: Ladelund
authors.affiliation: Gastrounit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Inge
authors.initials: I
authors.lastname: Nordgaard-Lassen
authors.affiliation: Gastrounit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Anette Mertz
authors.initials: AM
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology*; D003430:Cross-Sectional Studies; D003718:Denmark; D005243:Feces / Q000737:chemistry*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012812:Sigmoidoscopy; D055815:Young Adult
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex
keywords: IBD; Inflammatory Bowel Disease; Marker; Outcome