title: Raised faecal calprotectin is associated with subsequent symptomatic relapse, in children and adolescents with inflammatory bowel disease in clinical remission.
abstract: Reliable data on inflammatory biomarkers for predicting relapse of paediatric inflammatory bowel disease (IBD) are lacking.
  
  
  
  To investigate the predictive value of faecal calprotectin (FC) and CRP for symptomatic relapse in pediatric IBD in clinical remission.
  
  
  
  In this cross-sectional cohort study, patients <18 years with Crohn's disease or ulcerative colitis in clinical remission ≥3 months were included. At baseline, clinical and biochemical disease activity were assessed using the abbreviated-Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index, and FC and CRP respectively. Disease course over the subsequent 12 months was retrospectively assessed.
  
  
  
  In total, 114 patients (56% males; median age 14.9 years) were included. Baseline FC was higher in patients that developed symptomatic relapse [median (IQR), relapse 370 μg/g (86-1100) vs. remission 122 μg/g (40-344), P = 0.003]. Baseline FC was predictive of symptomatic relapse within 6 months [HR per 250 μg/g (95% CI): 1.46 (1.21-1.77), P < 0.001], with good predictive accuracy (AUC: 0.82). Optimal FC cut-off was 350 μg/g, with positive and negative predictive value of 41% and 96%. Baseline CRP was higher in patients that developed symptomatic relapse [median (IQR), relapse 1.0 μg/g (0.6-5.0) vs. remission 1.0 μg/g (0.4-2.0), P = 0.033]. Baseline CRP was predictive of symptomatic relapse within 6 months from baseline [HR per 1 mg/L (95% CI): 1.10 (1.02-1.19), P = 0.011], with fair predictive accuracy (AUC: 0.72). Optimal CRP cut-off was 1.0 mg/L, with positive and negative predictive value of 21% and 94%.
  
  
  
  Faecal calprotectin and CRP are predictive of symptomatic relapse and may be valuable in management of paediatric IBD in clinical remission.
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: K
authors.identifier: 0000-0001-8486-7557
authors.initials: K
authors.lastname: Diederen
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: D R
authors.initials: DR
authors.lastname: Hoekman
authors.affiliation: Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Leek
authors.affiliation: Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: V M
authors.initials: VM
authors.lastname: Wolters
authors.affiliation: Department of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: T Z
authors.initials: TZ
authors.lastname: Hummel
authors.affiliation: Department of Pediatric Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: T G
authors.initials: TG
authors.lastname: de Meij
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: B G P
authors.initials: BG
authors.lastname: Koot
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M M
authors.initials: MM
authors.lastname: Tabbers
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Kindermann
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000097:blood / Q000378:metabolism*; D003424:Crohn Disease / Q000097:blood / Q000378:metabolism*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D012008:Recurrence
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein