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What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clinical remission?

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Abstract

Purpose

Noninvasive markers for predicting endoscopic remission (ER) in patients with ulcerative colitis (UC) who are in clinical remission (CR) are important for the determination of appropriate treatment modality. C-reactive protein (CRP) is a surrogate marker for assessing disease activity, albeit with a low sensitivity and specificity when the cut-off value is 0.3 or 0.5 mg/dL, which is usually considered normal. The CRP test has been improved, and even fine values within the normal range can be measured. The aim of this study was to determine the appropriate cut-off value of CRP below 0.3 mg/dL for the prediction of ER in UC patients with CR.

Methods

A total of 132 patients who underwent endoscopic evaluation during CR were retrospectively reviewed. Clinical and endoscopic activity was measured using a simple clinical colitis activity index (SCCAI) and Mayo endoscopic subscore (MES). ER was defined as MES 0 or 1.

Results

In UC patients in CR, the CRP level was significantly lower in ER (0.05, 0.03–2.57) vs. non-ER (0.14, 0.03–2.81) (p < 0.001). The CRP value predicted ER [area under the curve (AUC = 0.710)] with a sensitivity of 71.4% and a specificity of 71.7% at a cut-off value of 0.09 mg/dL. In contrast, the value of normal CRP (< 0.3 mg/dL) did not show sufficient predictive value (sensitivity, 27.3%; and specificity, 90.9%).

Conclusions

In UC patients in CR, it may be helpful to lower the CRP cut-off value that predict ER other than 0.3 mg/dL, which is usually considered normal.

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Funding

This work was supported by a National Research Foundation of Korea (NRF) grant awarded by the Korean government (MSIP) (no. NRF-2017R1A2B4006767).

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Authors and Affiliations

  1. Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, Korea

    Jongbeom Shin, Sung Min Kong, Gyeol Seong & Young-Ho Kim

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  1. Jongbeom Shin
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  2. Sung Min Kong
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  3. Gyeol Seong
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  4. Young-Ho Kim
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Contributions

J Shin made substantial contribution to the conception and design, data acquisition, analysis, or interpretation and drafted the initial manuscripts, and reviewed and revised the final manuscript. Sung Min Kong and Gyeol Seong contributed to the conception and design, data acquisition, analysis, and interpretation. YH Kim was responsible for the conception and design of the study, data acquisition, analysis and interpretation, as well as drafting of the manuscript.

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Correspondence to Young-Ho Kim.

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Shin, J., Kong, S.M., Seong, G. et al. What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clinical remission?. Int J Colorectal Dis 35, 2249–2255 (2020). https://doi.org/10.1007/s00384-020-03705-9

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