title: Fecal Calprotectin Predicts Relapse and Histological Mucosal Healing in Ulcerative Colitis.
abstract: BACKGROUND
  Mucosal healing in ulcerative colitis leads to a decreased need for medication and decreased risk of disease relapse and colectomy. Histological healing seems to improve the disease prognosis even further. An assessment of both endoscopic and histological mucosal healing requires endoscopy, and the need for a reliable noninvasive biomarker to predict disease relapse is obvious.
  
  
  METHODS
  Seventy patients were included and followed up for 12 months. Inclusion criteria were a total Mayo score ≤1 and a Mayo endoscopic score = 0. The patients underwent sigmoidoscopy with rectal biopsies. Fecal calprotectin (FC) was measured 2 to 3 days before the sigmoidoscopy. The tissue samples were evaluated for neutrophilic inflammation. We aimed at testing the predictive performance of FC and histological inflammatory activity on disease relapse.
  
  
  RESULTS
  A baseline FC level of more than 321 mg/kg predicted disease relapse at both the 6- and 12-month follow-ups. Histological inflammatory activity, C-reactive protein, or length of remission was not predictive of relapse. Of note, 11.8% of all patients had histological inflammatory activity despite endoscopic remission and were found to have a higher level of FC (236.5 versus 56 mg/kg, P = 0.02). A receiver operating characteristic analysis estimated a cutoff level of ≤40.5 mg/kg for FC (area under the curve, 0.755 and confidence interval 95%, 0.5895-0.9208) for predicting a histological inflammatory activity score of 0.
  
  
  CONCLUSIONS
  FC measurements can be used to identify patients with increased risk of relapse after 6 and 12 months and to predict histological mucosal healing. Regular measurement of FC may alter disease monitoring and improve prognosis, and may decrease the need for endoscopy.
authors.affiliation: *Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; †Department of Pathology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; and ‡Department of Statistics and Department of Orthopaedic Surgery, Clinical Research Center, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Klaus
authors.initials: K
authors.lastname: Theede
authors.forename: Susanne
authors.initials: S
authors.lastname: Holck
authors.forename: Per
authors.initials: P
authors.lastname: Ibsen
authors.forename: Thomas
authors.initials: T
authors.lastname: Kallemose
authors.forename: Inge
authors.initials: I
authors.lastname: Nordgaard-Lassen
authors.forename: Anette Mertz
authors.initials: AM
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism*; D003093:Colitis, Ulcerative / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D009092:Mucous Membrane / Q000378:metabolism* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012812:Sigmoidoscopy; D014945:Wound Healing
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex