title: Rapid fecal calprotectin testing to assess for endoscopic disease activity in inflammatory bowel disease: A diagnostic cohort study.
abstract: OBJECTIVE
  With increasing numbers of patients diagnosed with inflammatory bowel disease (IBD), it is important to identify noninvasive methods of detecting disease activity. The aim of this study is to examine the diagnostic accuracy of fecal rapid calprotectin (FC) testing in the detection of endoscopically active IBD.
  
  
  METHODS
  All consecutive patients presenting to outpatient clinics with lower gastrointestinal symptoms were prospectively recruited. Patients provided FC samples. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) for FC were calculated. Receiver-operator characteristics (ROC) curve was used to identify the ideal FC cutoff that predicts endoscopic disease activity. Correlation between FC and endoscopic disease activity, disease location, and C-reactive protein (CRP) levels were measured.
  
  
  RESULTS
  One hundred and twenty-six patients, of whom 52% were females, were included in the final analysis with a mean age of 44.4 ± 16.7 years. Comparing FC to endoscopic findings, the following results were calculated: A cutoff point of 100 μg/g showed Sn = 83%, Sp = 67%, PPV = 65%, and NPV = 85%; and 200 μg/g showed Sn = 66%, Sp = 82%, PPV = 73%, and NPV = 77%. Based on ROC curve, the best FC cutoff point to predict endoscopic disease activity was 140 μg/g. Using this reference, FC levels strongly correlated with colorectal, ileocolonic, and ileal disease and predicted endoscopic activity.
  
  
  CONCLUSIONS
  FC is an accurate test when used as an initial screening tool for patients suspected of having active IBD. Given its noninvasive nature, it may prove to reduce the need for colonoscopy and be an added tool in the management of IBD.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Kwapisz
authors.affiliation: Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario; Department of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia, .
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Mosli
authors.forename: Nilesh
authors.initials: N
authors.lastname: Chande
authors.forename: Brian
authors.initials: B
authors.lastname: Yan
authors.forename: Melanie
authors.initials: M
authors.lastname: Beaton
authors.forename: Jessica
authors.initials: J
authors.lastname: Micsko
authors.forename: Pauline W
authors.initials: PW
authors.lastname: Mennill
authors.forename: William
authors.initials: W
authors.lastname: Barnett
authors.forename: Kevin
authors.initials: K
authors.lastname: Bax
authors.forename: Terry
authors.initials: T
authors.lastname: Ponich
authors.forename: John
authors.initials: J
authors.lastname: Howard
authors.forename: Anthony
authors.initials: A
authors.lastname: Tirolese
authors.forename: Robert
authors.initials: R
authors.lastname: Lannigan
authors.forename: James
authors.initials: J
authors.lastname: Gregor
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000378:metabolism; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis / Q000378:metabolism; D016145:Endoscopy, Digestive System / Q000379:methods; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000378:metabolism*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein