title: Fecal calprotectin and its correlation with inflammatory markers and endoscopy in patients from India with inflammatory bowel disease.
abstract: BACKGROUND
  In clinical practice, endoscopic findings are often used for assessing disease activity in inflammatory bowel disease (IBD). In recent years, blood and stool markers are being increasingly used for this purpose. Among them, the fecal calprotectin (FC) level is probably the most favored. Data on the reliability of FC are lacking from countries like India, where gut infections are common.
  
  
  OBJECTIVE
  The aims of this study were to compare the FC level with the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) as non-invasive markers of IBD and, in patients with ulcerative colitis (UC), and to study its correlation with disease extent, clinical activity, and endoscopic severity.
  
  
  METHODS
  Records of patients with IBD who had tests for FC, ESR and CRP and colonoscopy done within a 2-week period, between 2012 and 2014, were retrieved. Sixty-three patients (UC 32, Crohn's disease [CD] 31) were included for analysis. ESR, CRP and FC were compared to endoscopy to assess inflammation.
  
  
  RESULTS
  Patients with UC had higher levels of FC than those with ileocolonic CD (median FC 800 mcg/g vs. 619 mcg/g, respectively; p = 0.04). FC levels correlated with CRP (r = 0.4, p < 0.001) but not with ESR (r = 0.21, p = 0.09). In patients with UC with endoscopic evidence of inflammation, more (86.9 %) had FC > 200 mcg/g (cut-off for disease activity in our laboratory) than had ESR >20 mm in the first hour (60.6 %) or positive CRP (65.6 %) (< 0.01); FC levels increased with increasing endoscopic Mayo score (p = 0.001) and Truelove-Witt's clinical severity score (p = 0.006), but did not correlate with disease extent (p = 0.7). The best FC cut-off level to identify 'active UC' (Mayo grade 2 or more) was 800 mcg/g.
  
  
  CONCLUSIONS
  Fecal calprotectin level correlates with CRP but not with ESR. In patients with UC with inflammation, FC > 200 mcg/g is more often positive than raised ESR or CRP; it also correlates with clinical and endoscopic activity but not with disease extent. FC level > 800 mcg/g can be used to differentiate active from inactive UC.
authors.affiliation: Division of Gastroenterology, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India. samanthrishi@gmail.com.
authors.forename: Hrishikesh
authors.initials: H
authors.lastname: Samant
authors.affiliation: Division of Gastroenterology, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
authors.forename: Devendra
authors.initials: D
authors.lastname: Desai
authors.affiliation: Division of Gastroenterology, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
authors.forename: Philip
authors.initials: P
authors.lastname: Abraham
authors.affiliation: Division of Gastroenterology, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Division of Gastroenterology, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
authors.forename: Tarun
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
authors.forename: Alpa
authors.initials: A
authors.lastname: Dherai
authors.affiliation: Department of Laboratory Medicine, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
authors.forename: Tester
authors.initials: T
authors.lastname: Ashavaid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D016099:Endoscopy, Gastrointestinal; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007194:India; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000473:pathology*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein
keywords: C-reactive protein; Fecal calprotectin; Inflammatory markers