P141 Faecal calprotectin correlates to UCEIS and can predict short-term recurrence in patients with ulcerative colitis

M. Naganuma*¹, T. Kobayashi², T. Kanai¹

¹Division of Gastroenterology and Hepatology, Keio University, Tokyo, Japan, ²Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan

Background

We recently reported that ulcerative colitis Index of Severity (UCEIS) of 0–1 is associated with better long-term prognosis while faecal calprotectin is a valuable biomarker for assessing the severity of UC. However, there have been only few large multi-centre cohort studies trying to predict short-term recurrences using faecal calprotectin (FCP).

Methods

The multi-centre prospective cohort study was conducted in 756 UC patients from 14 Japanese academic institutions. Median FCP level on each score of UCEIS (range 0–7) was calculated (Cohort 1) and the correlation between FCP and UCEIS was assessed using Kruskal–Wallis analysis. We also assessed the association of FCP level and clinical recurrence (partial Mayo score>2) in quiescent UC patients (partial Mayo score of 0–1) using the log-rank test and cox proportional hazard model(Cohort 2). A receiver-operating characteristic curve analysis was conducted to determine the cut-off value of the FCP at baseline for predicting mucosal healing and clinical recurrence. FC was measured by Fluoro Enzyme Immunoassay using EliA Calprotectin 2.

Results

The median FCP level increased gradually as UCEIS become higher (p < 0.001) although FCP level is difficult to distinct between UCEIS of 0 (IQR:18.8–143.8) and 1 (IQR: 32.9–222.8) or UCEIS of 2 (IQR: 39.8–862.0) and 3 (IQR: 81.4–858.3). Each UCEIS subscore (vessel, bleeding, and erosion/ulcers) strongly correlated to FCP level (all items; p < 0.001). A cut-off value of 131 mg/kg for FCP level had a sensitivity of 75% and a specificity of 71% to predict UCEIS of 0-1. In Cohort 2, 24 (6.3%) and 90 (23.7%) of 379 quiescent patients had recurrences within 3 and 12 months, respectively. A cut-off value of 156 mg/kg for FCP level had a sensitivity of 68% and a specificity of 82% to predict recurrence within 12 months. The recurrence rate in patients with FCP ≥ 156 mg/kg (55.4%) was significantly higher (p < 0.001) than those with FCP < 156 mg/kg (12.2%). In a multi-variate analysis, FCP ≥ 156 mg/kg was an independent risk for recurrence (HR 6.2; 95% CI 3.6–10.6). Regarding the recurrence within 3 months, a cut-off value of 263.5 mg/kg for FCP had a sensitivity of 56% and a specificity of 84% to predict recurrence. The recurrence rate within 3 months in patients with FCP ≥ 263.5 mg/g (31.6%) was significantly higher (p < 0.001) than those with FCP < 263.5 mg/kg (5.7%). Only 2 (1.4%) 144 patients with FCP < 30.6 mg/kg had recurrences within 3 months.

Conclusion

FCP levels are strongly correlated to UCEIS and appears to be predictors of both short- and middle-term of recurrence in quiescent UC patients.

Posted in: Poster presentations: Clinical: Diagnosis and outcome (2019)