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P216. Fecal calprotectin and lactoferrin as predictors of relapse in patients with quiescent ulcerative colitis during maintenance therapy

T. Yamamoto, M. Shiraki, S. Umegae, K. Matsumoto, Yokkaichi Social Insurance Hospital, Inflammatory Bowel Disease Centre, Yokkaichi, Japan

Background

Predictive markers for relapse in patients with ulcerative colitis (UC) on mesalazine maintenance therapy have not been fully determined. Levels of fecal calprotectin and lactoferrin have a proportional correlation to the degree of inflammation of the intestinal mucosa. Fecal lactoferrin and lactoferrin may have a role in monitoring disease activity in patients with IBD. This prospective study was to evaluate the significance of fecal calprotectin and lactoferrin for the prediction of UC relapse.

Methods

Eighty UC patients in remission for ≥3 months on mesalazine as maintenance therapy were included. At entry, stool samples were collected for the measurement of calprotectin and lactoferrin. All patients were followed up for the following 12 months. To identify predictive factors for relapse, time-dependent analyses using the Kaplan–Meier graphs and Cox's proportional hazard model were applied.

Results

During the 12-month, 21 patients relapsed. Mean calprotectin and lactoferrin levels were significantly higher in patients with relapse than those in remission (calprotectin: 173.7 vs 135.5 µg/g, P = 0.02 and lactoferrin: 165.1 vs 130.7 µg/g, P = 0.03). A cutoff value of 170 µg/g for calprotectin had a sensitivity of 76% and a specificity of 76% to predict relapse, while a cutoff value of 140 µg/g for lactoferrin had a sensitivity of 67% and a specificity of 68%. In a multivariate analysis, calprotectin (≥170 µg/g) was a predictor of relapse (hazard ratio, 7.23; P = 0.002). None of the following parameters were significantly associated with relapse: age, gender, duration of UC, number of UC episode, severity of the previous episode, extent of UC, extraintestinal manifestation, and lactoferrin level.

Conclusion

This study showed that both fecal calprotectin and lactoferrin levels were very significantly increased in patients with UC even during remission as compared with healthy controls. Further, fecal calprotectin level ≥170 µg/g was associated with a clinical relapse. Fecal calprotectin level appeared to be a significant predictor of relapse in patients with quiescent UC on mesalamine as maintenance therapy.