Impact of faecal calprotectin measurement on clinical decision-making in patients with Crohn’s disease and ulcerative colitis

Autoři: Anna Luisa Bathe aff001;  Eirini Mavropoulou aff001;  Nicolae-Catalin Mechie aff001;  Golo Petzold aff001;  Volker Ellenrieder aff001;  Steffen Kunsch aff001;  Ahmad Amanzada aff001
Působiště autorů: Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Lower Saxony, Germany aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Faecal calprotectin (FC) seems to be the best available biomarker for the detection of intestinal inflammation in patients with inflammatory bowel disease (IBD). The aim of this study is to clarify whether the measurement of FC has changed the number of ultrasound and endoscopic procedures, drug modifications, as well as FC re-measurements in IBD patients.


This retrospective study included 242 IBD patients with available FC values (case cohort) and 46 patients without an available FC value (control cohort). Clinical consequences such as carrying out abdominal ultrasound, endoscopy, drug modification or FC re-measurement at the next ambulatory presentation or during in-patient stay were collected. Statistical analysis was performed to determine the association between clinical decision-making and patient’s characteristics, especially FC value.


Overall, 192 (67%) clinical consequences were noted in both cohorts. In the case cohort 174 (91%) implications were noted compared to 18 (9%) in the control cohort (P < 0.001). In the case cohort, significantly more clinical consequences were detected in patients with Crohn’s disease (CD) as well as in ulcerative colitis (UC) patients with a FC value > 250 mg/Kg than in patients with a value of ≤ 250 mg/Kg. In CD patients with high FC values significantly increased numbers of abdominal ultrasounds, endoscopies and FC re-measurements were noted. In UC patients with high FC values significantly increased numbers of abdominal ultrasounds, drug modifications and FC re-measurements were noted.


Measurement of FC may alter physician’s clinical decision-making in IBD patients beside other clinical and diagnostic parameters. Further prospective and survey studies are warranted to evaluate the influence of FC measurement in the daily clinical decision-making.

Klíčová slova:

Decision making – Endoscopy – Inflammatory bowel disease – Physicians – Platelets – Ulcerative colitis – Ultrasound imaging


1. Rogler G, Aldeguer X, Kruis W, Lasson A, Mittmann U, Nally K, et al. Concept for a rapid point-of-care calprotectin diagnostic test for diagnosis and disease activity monitoring in patients with inflammatory bowel disease: Expert clinical opinion. J Crohns Colitis. 2013;7:670–7. doi: 10.1016/j.crohns.2013.02.014 23517932

2. Heida A, Park KT, van Rheenen PF. Clinical Utility of Fecal Calprotectin Monitoring in Asymptomatic Patients with Inflammatory Bowel Disease: A Systematic Review and Practical Guide. Inflamm Bowel Dis. 2017;23:894–902. doi: 10.1097/MIB.0000000000001082 28511198

3. Carter MJ, Lobo AJ, Travis SPL. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004;53:V1–V16. doi: 10.1136/gut.2004.043372 15306569

4. Lin JF, Chen JM, Zuo JH, Yu A, Xiao ZJ, Deng FH, et al. Meta-analysis: Fecal Calprotectin for Assessment of Inflammatory Bowel Disease Activity. Inflamm Bowel Dis. 2014;20:1407–15. doi: 10.1097/MIB.0000000000000057 24983982

5. Dignass A, Eliakim R, Magro F, Maaser C, Chowers Y, Geboes K, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 1: Definitions and diagnosis. J Crohns Colitis. 2012;6:965–90. doi: 10.1016/j.crohns.2012.09.003 23040452

6. Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis. J Crohns Colitis. 2010;4:7–27. doi: 10.1016/j.crohns.2009.12.003 21122488

7. Rokkas T, Portincasa P, Koutroubakis IE. Fecal Calprotectin in Assessing Inflammatory Bowel Disease Endoscopic Activity: a Diagnostic Accuracy Meta-analysis. J Gastrointestin Liver Dis. 2018;27:299–306. doi: 10.15403/jgld.2014.1121.273.pti 30240474

8. Smith LA, Gaya DR. Utility of faecal calprotectin analysis in adult inflammatory bowel disease. World J Gastroenterol. 2012;18:6782–9. doi: 10.3748/wjg.v18.i46.6782 23239916

9. Mumolo MG, Bertani L, Ceccarelli L, Laino G, Di Fluri G, Albano E, et al. From bench to bedside: Fecal calprotectin in inflammatory bowel diseases clinical setting. World J Gastroenterol. 2018;24:3681–94. doi: 10.3748/wjg.v24.i33.3681 30197475

10. Røseth AG, Schmidt PN, Fagerhol MK. Correlation between Faecal Excretion of Indium-111-Labelled Granulocytes and Calprotectin, a Granulocyte Marker Protein, in Patients with Inflammatory Bowel Disease. Scand J Gastroenterol. 1999;34:50–4. doi: 10.1080/00365529950172835 10048733

11. Motaganahalli S, Beswick L, Con D, van Langenberg DR. Faecal calprotectin delivers on convenience, cost reduction and clinical decision making in inflammatory bowel disease: a real world cohort study. Intern Med J. 2019;49:94–100. doi: 10.1111/imj.14027 29962008

12. Naismith GD, Smith LA, Barry SJE, Munro JI, Laird S, Rankin K, et al. A prospective single-centre evaluation of the intra-individual variability of faecal calprotectin in quiescent Crohn's disease. Aliment Pharmacol Ther. 2013;37:613–21. doi: 10.1111/apt.12221 23347334

13. Langhorst J, Elsenbruch S, Koelzer J, Rueffer A, Michalsen A, Dobos GJ. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices. Am J Gastroenterol. 2008;103:162–9. doi: 10.1111/j.1572-0241.2007.01556.x 17916108

14. Chen JM, Liu T, Gao S, Tong XD, Deng FH, Nie B. Efficacy of noninvasive evaluations in monitoring inflammatory bowel disease activity: A prospective study in China. World J Gastroenterol. 2017;23:8235–47. doi: 10.3748/wjg.v23.i46.8235 29290660

15. Xiang JY, Ouyang Q, Li GD, Xiao NP. Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis. World J Gastroenterol. 2008;14:53–7. doi: 10.3748/wjg.14.53 18176961

16. D'Haens G, Ferrante M, Vermeire S, Baert F, Noman M, Moortgat L, et al. Fecal Calprotectin is a Surrogate Marker for Endoscopic Lesions in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2012;18:2218–24. doi: 10.1002/ibd.22917 22344983

17. Lin WC, Wong JM, Tung CC, Lin CP, Chou JW, Wang HY, et al. Fecal calprotectin correlated with endoscopic remission for Asian inflammatory bowel disease patients. World J Gastroenterol. 2015;21:13566–73. doi: 10.3748/wjg.v21.i48.13566 26730169

18. Zittan E, Kelly OB, Gralnek IM, Silverberg MS, Hillary Steinhart A. Fecal calprotectin correlates with active colonic inflammatory bowel disease but not with small intestinal Crohn's disease activity. JGH Open. 2018;2:201–6. doi: 10.1002/jgh3.12068 30483590

19. Mosli MH, Zou G, Garg SK, Feagan SG, MacDonald JK, Chande N, et al. C-Reactive Protein, Fecal Calprotectin, and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2015;110:802–819. doi: 10.1038/ajg.2015.120 25964225

20. Costa F, Mumolo MG, Ceccarelli L, Bellini M, Romano MR, Sterpi C, et al. Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn's disease. Gut. 2005;54:364–8. doi: 10.1136/gut.2004.043406 15710984

21. IBD Clinic. Modified Harvey Bradshaw Index Assessment for Crohn’s Disease Activity. Cited 15.01.2019.

22. IBD Clinic. Partial Mayo Scoring Index Assessment for Ulcerative Colitis Activity. Cited 15.01.2019.

23. Silverberg MS, Satsangi J, Ahmad T, Arnott I, Bernstein CN, Brant SR, et al. Toward an Integrated Clinical, Molecular and Serological Classification of Inflammatory Bowel Disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19:5A–36A. doi: 10.1155/2005/269076 16151544

24. Huang VW, Prosser C, Kroeker KI, Wang H, Shalapay C, Dhami N, et al. Knowledge of Fecal Calprotectin and Infliximab Trough Levels Alters Clinical Decision-making for IBD Outpatients on Maintenance Infliximab Therapy. Inflamm Bowel Dis. 2015;21:1359–67. doi: 10.1097/MIB.0000000000000376 25989340

25. Rosenfeld G, Greenup AJ, Round A, Takach O, Halparin L, Saadeddin A, et al. FOCUS: Future of fecal calprotectin utility study in inflammatory bowel disease. World J Gastroenterol. 2016;22:8211–8. doi: 10.3748/wjg.v22.i36.8211 27688663

26. Abej E, El-Matary W, Singh H, Bernstein CN. The Utility of Fecal Calprotectin in the Real-World Clinical Care of Patients with Inflammatory Bowel Disease. Can J Gastroenterol Hepatol. 2016;2016:2016:2483261. doi: 10.1155/2016/2483261 27774443

27. El-Matary W, Abej E, Deora V, Singh H, Bernstein CN. Impact of Fecal Calprotectin Measurement on Decision-making in Children with Inflammatory Bowel Disease. Front Pediatr. 2017;5:7. doi: 10.3389/fped.2017.00007 28180127

28. Derwa Y, Williams CJM, Sood R, Mumtaz S, Bholah MH, Selinger CP, et al. Factors affecting clinical decision-making in inflammatory bowel disease and the role of point-of-care calprotectin. Therap Adv Gastroenterol. 2018;11:1–18. doi: 10.1177/1756283X17744739 29383026

29. Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): Determining Therapeutic Goals for Treat-to-Target. Am J Gastroenterol. 2015;110:1324–38. doi: 10.1038/ajg.2015.233 26303131

30. Vermeire S, Van Assche G, Rutgeerts P. The role of C-reactive protein as an inflammatory marker in gastrointestinal diseases. Nat Clin Pract Gastroenterol Hepatol. 2005;2:580–6. doi: 10.1038/ncpgasthep0359 16327837

31. Saverymuttu SH, Hodgson HJF, Chadwick VS, Pepys MB. Differing acute phase responses in Crohn's disease and ulcerative colitis. Gut. 1986;27:809–13. doi: 10.1136/gut.27.7.809 3732890

32. Peyrin-Biroulet L, Panés J, Sandborn WJ, Vermeire S, Danese S, Feagan BG, et al. Defining Disease Severity in Inflammatory Bowel Diseases: Current and Future Directions. Clin Gastroenterol Hepatol. 2016;14:348–354. doi: 10.1016/j.cgh.2015.06.001 26071941

33. Panés J, Bouzas R, Chaparro M, García-Sánchez V, Gisbert JP, Martínez de Guereñu B, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Aliment Pharmacol Ther. 2011;34:125–45. doi: 10.1111/j.1365-2036.2011.04710.x 21615440

34. Galgut BJ, Lemberg DA, Day AS, Leach ST. The Value of Fecal Markers in Predicting Relapse in Inflammatory Bowel Diseases. Front Pediatr. 2018;5:292. doi: 10.3389/fped.2017.00292 29404311

35. Wright EK, Kamm MA, De Cruz P, Hamilton AL, Ritchie KJ, Krejany EO, et al. Measurement of Fecal Calprotectin Improves Monitoring and Detection of Recurrence of Crohn's Disease After Surgery. Gastroenterology. 2015;148:938–947. doi: 10.1053/j.gastro.2015.01.026 25620670

36. Colombel JF, Panaccione R, Bossuyt P, Lukas M, Baert F, Vaňásek T, et al. Effect of tight control management on Crohn's disease (CALM): a multicentre, randomised, controlled phase 3 trial. Lancet. 2017;390:2779–89. doi: 10.1016/S0140-6736(17)32641-7 29096949

37. Parente F, Molteni M, Marino B, Colli A, Ardizzone S, Greco S, et al. Are Colonoscopy and Bowel Ultrasound Useful for Assessing Response to Short-Term Therapy and Predicting Disease Outcome of Moderate-to-Severe Forms of Ulcerative Colitis?: A Prospective Study. Am J Gastroenterol. 2010;105:1150–7. doi: 10.1038/ajg.2009.672 19997096

38. De Vos M, Louis EJ, Jahnsen J, Vandervoort JGP, Noman M, Dewit O, et al. Consecutive fecal calprotectin measurements to predict relapse in patients with ulcerative colitis receiving infliximab maintenance therapy. Inflamm Bowel Dis. 2013;19:2111–7. doi: 10.1097/MIB.0b013e31829b2a37 23883959

39. Prager M, Büning C. Klinik, CRP, Calprotectin, MRT oder Endoskopie? Strategien zur sinnvollen Therapieüberwachung bei CED. coloproctology. 2014;36:250–8. doi: 10.1007/s00053-014-0464-7

40. Lee SH, Kim MJ, Chang K, Song EM, Hwang SW, Park SH, et al. Fecal calprotectin predicts complete mucosal healing and better correlates with the ulcerative colitis endoscopic index of severity than with the Mayo endoscopic subscore in patients with ulcerative colitis. BMC Gastroenterol. 2017;17:110. doi: 10.1186/s12876-017-0669-7 29061121

41. Sandborn WJ, Panés J, Zhang H, Yu D, Niezychowski W, Su C. Correlation Between Concentrations of Fecal Calprotectin and Outcomes of Patients With Ulcerative Colitis in a Phase 2 Trial. Gastroenterology. 2016;150:96–102. doi: 10.1053/j.gastro.2015.09.001 26376350

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