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P172. Fecal calprotectin (FC) is a useful early predictive marker for postoperative recurrence in Crohn's disease (CD)

B. Beltrán1, E. Cerrillo2, M. Iborra1, I. Moret3, F. Rausell3, L. Tortosa3, G. Bastida1, M. Aguas1, P. Nos1

1La Fe Hospital/CIBEREHD, Gastroenterology, Valencia, Spain; 2La Fe Hospital, Gastroenterology, Valencia, Spain; 3IIS Hospital La Fe/CIBEREHD, Valencia, Spain

Background: FC levels have shown to correlate with clinical and endoscopic activity in CD. Its utility in the postoperative setting remains to be clarified, as well as the time needed for its normalization after surgery and, subsequently, the optimal cut-off value at which theirs levels may be indicative of recurrence. Aims: To assess the potential use of FC in identifying CD patients who will present recurrent disease. To find the best cut-off value of FC to discriminate the presence of recurrence. To clarify the time needed for normalization of FC after surgery.

Methods: A cohort of 26 patients who underwent a resection for CD were prospectively followed for 12 months. Stool and blood samples for FC, CRP and Fibrinogen measurements were obtained before and after surgery (with regular measurements every 3 months). Measurements compared patient with and without recurrence. FC values were determined by ELISA. Morphological recurrence was assessed by ileocolonoscopy or MRI enterography within 9–12 months after surgery. Statistical analysis was performed with Mann-Witney test. To select a cut-off for FC a ROC curve was calculated.

Results: Seventeen patients (65.4%) (46±3.7 yo) have not recurred whereas 9 have recurred (34.6%) (44.56±5.9). 92.3% of the patients received treatment for recurrence prevention (15.4% mesalazine, 46.2% azathioprine and 30.8% biological therapy). FC measurements are shown in the table. CRP and Fibrinogen shown are values corresponding to when morphological evaluation was done (*). Harvey index was 2.25±1.8 in non recurred and 3.5±1.29 in recurred (p = 0.08). CRP, Fibring and Harvey index got increased over normal limit in recurred patients later than FC (not shown). ROC curve for FC gave an AUC of 0.979 (CI 0.93–1.02). Recurrence was best predicted by FC of ≥175 mg/ml (100% sensitivity, 76.5% especificity 76.5%, 75% PPV, 100% PNV). A significant linear correlation between FC and CRP (r 0.47, p < 0.02) was detected even CRP was below upper normal limit.

#Normal values: CRP (<8); Fibrinogen (<437).
FC (µg/g)1st month3rd month6th month12th month*CRP *# (mg/L)Fib *# (mg/dl)
Non recurrence228.7±76247±69.7162.5±42.7113±21.52.3±0.5328±13.7
Recurrence 12th m po461±124259±51.1349±108597±62.95.4±1.2449±42.7
p   0.000010.020.002

Conclusions: FC is a useful early non-invasive marker for assessing recurrence in CD. A cutoff of 175 mg/ml for FC is proposed. FC after surgery would be already useful at month six.