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Am J Gastroenterol. 2015 Jun;110(6):802-19; quiz 820. doi: 10.1038/ajg.2015.120. Epub 2015 May 12.

C-Reactive Protein, Fecal Calprotectin, and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis.

Author information

1
1] Department of Medicine, University of Western Ontario, London, Ontario, Canada [2] Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia [3] Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
2
1] Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada [2] Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.
3
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
4
Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada.
5
1] Department of Medicine, University of Western Ontario, London, Ontario, Canada [2] London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada.
6
1] Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada [2] Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.
7
1] Department of Medicine, University of Western Ontario, London, Ontario, Canada [2] Robarts Clinical Trials, Robarts Research Institute, London, Ontario, Canada [3] Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.

Abstract

OBJECTIVES:

Persistent disease activity is associated with a poor prognosis in inflammatory bowel disease (IBD). Therefore, monitoring of patients with intent to suppress subclinical inflammation has emerged as a treatment concept. As endoscopic monitoring is invasive and resource intensive, identification of valid markers of disease activity is a priority. The objective was to evaluate the diagnostic accuracy of C-reactive protein (CRP), fecal calprotectin (FC), and stool lactoferrin (SL) for assessment of endoscopically defined disease activity in IBD.

METHODS:

Databases were searched from inception to November 6, 2014 for relevant cohort and case-control studies that evaluated the diagnostic accuracy of CRP, FC, or SL and used endoscopy as a gold standard in patients with symptoms consistent with active IBD. Sensitivities and specificities were pooled to generate operating property estimates for each test using a bivariate diagnostic meta-analysis.

RESULTS:

Nineteen studies (n=2499 patients) were eligible. The pooled sensitivity and specificity estimates for CRP, FC, and SL were 0.49 (95% confidence interval (CI) 0.34-0.64) and 0.92 (95% CI 0.72-0.96), 0.88 (95% CI 0.84-0.90) and 0.73 (95% CI 0.66-0.79), and 0.82 (95% CI 0.73-0.88) and 0.79 (95% CI 0.62-0.89), respectively. FC was more sensitive than CRP in both diseases and was more sensitive in ulcerative colitis than Crohn's disease.

CONCLUSIONS:

Although CRP, FC, and SL are useful biomarkers, their value in managing individual patients must be considered in specific clinical contexts.

PMID:
25964225
DOI:
10.1038/ajg.2015.120
[Indexed for MEDLINE]

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