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J Crohns Colitis. 2017 Apr 1;11(4):435-444. doi: 10.1093/ecco-jcc/jjw170.

Accuracy of Faecal Calprotectin and Neutrophil Gelatinase B-associated Lipocalin in Evaluating Subclinical Inflammation in UlceRaTIVE Colitis-the ACERTIVE study.

Author information

1
Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.
2
Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.
3
MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.
4
Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.
5
Department of Gastroenterology, Centro Hospitalar do Algarve - Portimão Unit, Portimão, Portugal.
6
Departament of Medicine and Medical Biosciences, University of Algarve, Faro, Portugal.
7
Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Portugal.
8
Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal.
9
Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal.
10
Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal.
11
Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal.
12
Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
13
Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
14
Department of Gastroenterology, Hospital de Braga, Braga, Portugal.
15
Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal.
16
Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
17
Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal.
18
CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
19
CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.
20
Department of Pathology, Centro Hospitalar São João, Porto, Portugal.
21
Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
22
Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium.
23
Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal.

Abstract

Background and Aims:

Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients.

Methods:

This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers.

Results:

Macroscopic lesions [i.e. endoscopic Mayo score ≥1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B-associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic-based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150-250 μg/g for faecal calprotectin and 12 μg/g for neutrophil gelatinase B-associated lipocalin were proposed.

Conclusions:

Faecal calprotectin and neutrophil gelatinase B-associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75-93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.

KEYWORDS:

Endoscopic and histological remission; faecal markers; ulcerative colitis

PMID:
27664275
DOI:
10.1093/ecco-jcc/jjw170
[Indexed for MEDLINE]

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