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P148 Fecal calprotectin as a noninvasive indicator for ulcerative colitis disease activity in the Korean cohort

Lee S.-H.*1, Seo H.1, Chang K.1, Song E.M.1, Kim G.-U.1, Seo M.1, Kwon E.J.1,2, Hwang S.W.1,2, Park S.H.1,2, Yang D.-H.1, Kim K.-J.1, Byeon J.-S.1, Myung S.-J.1, Yang S.-K.1,2, Ye B.D.1,2

1University of Ulsan College of Medicine, Asan Medical Center, Department of Gastroenterology, Seoul, South Korea 2University of Ulsan College of Medicine, Asan Medical Center, Inflammatory Bowel Disease Center, Seoul, South Korea

Background

The aim of this study was to evaluate the diagnostic role of fecal calprotectin (FC) as a noninvasive marker for the disease activity of ulcerative colitis (UC) in the Korean cohort.

Methods

A total of 168 fecal samples were collected from 168 UC patients (April 2015-September 2016). FC was measured using the Quantum Blue® Calprotectin rapid test (Bühlmann Laboratories AG, Schönenbuch, Switzerland). The results of laboratory tests, partial Mayo score and colonoscopic imaging conducted at the time of fecal calprotectin measurement were retrospectively reviewed. Mayo endoscopic subscore and UC endoscopic index of severity (UCEIS) were graded by two certified endoscopists after training on another 50 cases.

Results

The mean (± standard deviation, SD) FC level was 3619.2±5344.5 μg/g and the median (interquartile range, IQR) partial Mayo score, Mayo endoscopic subscore, and UCEIS were 5 (3–6), 3 (2–3), and 4 (3–6), respectively.

The FC levels were significantly correlated with partial Mayo score (Spearman correlation coefficient r=0.387, p<0.001), Mayo score (r=0.383, p<0.001), and UCEIS (r=0.378, p<0.001). The correlation with FC was significantly greater for UCEIS than for Mayo endoscopic subscore (Meng's z=−3.057, p=0.002). Among the laboratory values, FC levels had significant correlations with C-reactive protein (r=0.368, p<0.001) and serum albumin (r=−0.393, p<0.001) (see Figure 1).

Figure 1. Correlation between FC and a) serum albumin (r=−0.393, p<0.001); b) CRP (r=0.368, p<0.001); c) partial Mayo score (r=0.387, p<0.001); d) Mayo score (r=0.383, p<0.001); e) Mayo endoscopic subscore (r=0.265, p=0.001); f) UCEIS (r=0.378, p<0.001).

In the receiver-operating-characteristics (ROC) curve analyses, the area under the curve (AUC) of FC for discriminating mucosal healing (Mayo endoscopic subscore 0–1), clinical remission (Mayo score 0–2), and UCEIS score 0–3 were 0.625 (95% confidence interval [CI] 0.506–0.744), 0.695 (95% CI 0.577–0.813), and 0.708 (95% CI 0.625–0.791), respectively (see Figure 2).

Figure 2. In the ROC curve analysis, AUC of FC for discriminating a) Mayo endoscopic subscore 0–1 was 0.625; b) Mayo score 0–2 was 0.695; c) UCEIS score 0–2 was 0.693; d) UCEIS score 0–3 was 0.708.

Conclusion

FC level showed significant correlation with the disease activity of UC, endoscopic indices and other serum inflammatory biomarkers in the Korean cohort. UCEIS showed a better correlation with FC level than Mayo endoscopic subscore. Fecal calprotectin could be used as a reliable noninvasive indicator to evaluate the disease activity and mucosal healing of UC.