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P189 Serum neutrophil gelatinase-associated lipocalin correlates with Mayo Clinic score in ulcerative colitis but fails to predict activity in Crohn's disease

Budzyńska A., Nowakowska-Duława E., Gawron-Kiszka M., Śpiewak J., Hartleb M.

Medical University of Silesia, Department of Gastroenterology & Hepatology, Katowice, Poland

Background

Hitherto used non-invasive biomarkers to diagnose and monitor activity of inflammatory bowel disease (IBD) show many shortcomings and cannot replace endoscopy. Neutrophil gelatinase-associated lipocalin (NGAL) is a low molecular weight protein released from activated neutrophils and necrotic epithelium whose mRNA expression is increased in inflamed intestinal tissue. Our aim was to explore the relationship between serum NGAL level and endoscopic/clinical activity of IBD.

Methods

A total of 120 patients, 79 with Crohn's disease (CD) and 41 with ulcerative colitis (UC) were prospectively included into the study. In each patient the colonoscopy was performed and routine laboratory tests, serum NGAL and faecal calprotectin levels were determined. The activity of IBD was assessed either by CDAI (Crohn's Disease Activity Index) or Mayo score according to IBD form.

Results

No significant differences were found between UC and CD patients for serum level of NGAL (74.7 vs. 66.5 ng/ml, p=0.26), CRP (21.2 vs. 19.4 mg/l, p=0.98) and faecal calprotectin (425 vs. 614 mg/kg, p=0.36). The transition of UC inflammation activity measured by Mayo score from remission to mild-moderate-severe form was associated with respective levels of NGAL: 37.0, 52.2, 84.9 and 92.9 ng/ml (p=0.001), CRP: 3.2, 6.6, 17.7 and 45.9 mg/l (p=0.004), and faecal calprotectin: 28.1, 874, 368 and 291 (p=0.03). Serum NGAL correlated with CRP (r=0.55), but not with faecal calprotectin. In CD patients no significant differences were found between 4 categories (inactive-mild-moderate-severe) by CDAI score for NGAL (p=0.93) and faecal calprotectin (p=0.43). By contrast, growing CDAI stages were associated with increasing CRP levels (7.8, 18.8, 23.7, 47.9 mg/l, p=0.04). Investigated biomarkers did not distinguish between colonic and ileal form of CD.

Conclusion

In UC patients serum NGAL corresponds to disease activity and correlates with CRP concentration, showing higher predictive efficacy than faecal calprotectin. In CD patients CRP shows better relationship with clinical activity than serum NGAL and faecal calprotectin.