CIBEREHD is funded by the Instituto de Salud Carlos III.
Fecal calprotectin and lactoferrin for the prediction of inflammatory bowel disease relapse†
Article first published online: 16 MAR 2009
Copyright © 2009 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 15, Issue 8, pages 1190–1198, August 2009
How to Cite
Gisbert, J. P., Bermejo, F., Pérez-Calle, J.-L., Taxonera, C., Vera, I., McNicholl, A. G., Algaba, A., López, P., López-Palacios, N., Calvo, M., González-Lama, Y., Carneros, J.-A., Velasco, M. and Maté, J. (2009), Fecal calprotectin and lactoferrin for the prediction of inflammatory bowel disease relapse. Inflamm Bowel Dis, 15: 1190–1198. doi: 10.1002/ibd.20933
- Issue published online: 15 JUL 2009
- Article first published online: 16 MAR 2009
- Manuscript Accepted: 7 JAN 2009
- Manuscript Received: 12 DEC 2008
- Crohn's disease;
- ulcerative colitis;
- inflammatory bowel disease;
- fecal marker;
- fecal marker;
- biological marker
The purpose of the study was to determine the role of fecal calprotectin and lactoferrin in the prediction of inflammatory bowel disease relapses, both in patients with ulcerative colitis (UC) and Crohn's disease (CD), in a large, long-term, follow-up study.
The prospective multicenter study included CD and UC patients who had been in clinical remission for 6 months. At baseline, patients provided a single stool sample for calprotectin and lactoferrin determination. Follow-up was 12 months in patients showing no relapse and until activity flare in relapsing patients.
In all, 163 patients (89 CD, 74 UC) were included. Twenty-six patients (16%) relapsed during follow-up. Calprotectin concentrations in patients who suffered a relapse were higher than in nonrelapsing patients (239 ± 150 versus 136 ± 158 μg/g; P < 0.001). Relapse risk was higher in patients having high (>150 μg/g) calprotectin concentrations (30% versus 7.8%; P < 0.001) or positive lactoferrin (25% versus 10%; P < 0.05). Fecal calprotectin (>150 μg/g) sensitivity and specificity to predict relapse were 69% and 69%, respectively. Corresponding values for lactoferrin were 62% and 65%, respectively. The area under the receiver operating characteristic curve to predict relapse using calprotectin determination was 0.73 (0.69 for UC and 0.77 for CD). Better results were obtained when only colonic CD disease or only relapses during the first 3 months were considered (100% sensitivity). High fecal calprotectin levels or lactoferrin positivity was associated with clinical relapse in Kaplan–Meier survival analysis, and both fecal tests were associated with relapse in the multivariate analysis.
Fecal calprotectin and lactoferrin determination may be useful in predicting impending clinical relapse—especially during the following 3 months—in both CD and UC patients. (Inflamm Bowel Dis 2009)