Potential of Fecal Calprotectin as an Objective Marker to Discriminate Hospitalized Patients with Acute Severe Colitis from Outpatients with Less Severe Disease
Acute severe colitis (ASC) is conventionally diagnosed by Truelove and Witts’ criteria which are non-specific and can be affected by other pathologic conditions. Fecal calprotectin (FCP) is a gut-specific marker of inflammation which can predict short-term outcomes in patients with ASC. We aimed to define the role of FCP in the diagnosis of ASC.
This prospective observational cohort study included adult patients (> 18 years) with ulcerative colitis (UC) for whom FCP was measured and was under follow-up from April 2015 to December 2016. Patients were divided into two cohorts: (1) all consecutive hospitalized patients with ASC as defined by Truelove and Witts’ criteria; (2) outpatients with active UC (defined by Mayo score) who did not fulfill Truelove and Witts’ criteria. FCP levels were compared between the two cohorts, and a cutoff for FCP to diagnose ASC was determined.
Of 97 patients, 49 were diagnosed with ASC (mean age: 36.1 ± 11.9 years, 36 males) and 48 with active UC (mean age: 37.9 ± 12.4 years, 25 males). Median FCP levels were significantly higher in patients with ASC [1776(952–3123) vs 282(43–568) µg/g, p < 0.001] than mild to moderately active UC (n = 48) or moderately active UC [n = 35, 1776(952–3123) vs 332(106–700) µg/g, p < 0.001]. A FCP cutoff of 782 μg/g of stool had excellent diagnostic accuracy, with an area under the curve of 0.92(95% CI 0.87–0.97), sensitivity of 84% and specificity of 88% to differentiate ASC from active UC.
FCP could differentiate ASC from mild to moderate patients with UC, but requires validation before clinical use.
KeywordsFecal calprotectin Acute severe colitis Ulcerative colitis Mayo score Hospitalization
Vineet Ahuja is the guarantor of the article, SK was involved in data acquisition, data analysis and drafting the manuscript, SJ and SG contributed to data acquisition and critical revision of the manuscript for important intellectual content, VS helped in analysis of fecal calprotectin, SB, DPY, PS, SP, NRD, SPLT, GM were involved in critical revision of the manuscript for important intellectual content, VA helped in study concept and design, drafting the manuscript and critical revision of the manuscript for important intellectual content. All authors have made significant contributions to the manuscript and agree with the content of the manuscript.
Compliance with ethical standards
Conflict of interest
None to declare.
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