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Low Levels of Fecal Calprotectin 3 Months After Surgery Predict Subsequent Endoscopic Postoperative Remission in Crohn’s Disease



In Crohn’s disease (CD) few data are available on the usefulness of monitoring fecal calprotectin (FC) in the early postoperative setting. We assessed prospectively the accuracy of FC measured 3 months after surgery to predict the risk of endoscopic postoperative recurrence (POR) within 1 year after resection.


In 55 consecutive CD patients who had undergone ileocolonic resection samples were collected 3 months after surgery for measuring serum CRP and FC. Endoscopic POR was assessed by ileocolonoscopy within 6–12 months (median 7 months). Receiver operating characteristic (ROC) curves were generated to assess accuracy of the markers, to determine the best threshold and to calculate sensitivity, specificity, positive and negative predictive values.


In contrast with median CRP levels, median FC concentrations measured 3 months after surgery were significantly higher in patients who later experienced endoscopic POR (Rutgeerts ≥ i2) compared with those who stayed in endoscopic remission within the following 6–12 months (205 μg/g IQR [106–721] vs. 103 μg/g IQR [60–219], p = 0.008). Area under the ROC curve for FC was 0.71. The best cutoff value of FC to identify patients in subsequent endoscopic remission 3 months after surgery was 65 μg/g (96% sensitivity, 31% specificity, 50% positive and 91% negative predictive values). In multivariate analysis, FC < 65 µg/g at 3 months was the only factor associated with subsequent endoscopic remission.


FC measured 3 months after surgery below 65 μg/g is an accurate marker to identify CD patients who will later stay in endoscopic remission within 1 year after resection.

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Fig. 1
Fig. 2



Fecal calprotectin


High sensitivity C-reactive protein


Crohn’s disease


Receiver operating characteristic


Area under the ROC curve


Interquartile range 25–75


Odds ratio

95% CI:

95% confidence interval


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Authors and Affiliations



Conception and design of the study: SN, GB, MF, XR, BF. Generation, collection, assembly, analysis and/or interpretation of data: drafting or revision of the manuscript: FV, GB, CM, CC, AC, RDL, PD, EC, VK, AM, MF, XR, BF, SN. Approval of the final version of the manuscript: FV, GB, CM, CC, AC, RDL, PD, EC, VK, AM, MF, XR, BF, SN. All the authors had access to all the study data and had reviewed and approved the present final manuscript.

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Correspondence to Stéphane Nancey.

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Veyre, F., Boschetti, G., Meunier, C. et al. Low Levels of Fecal Calprotectin 3 Months After Surgery Predict Subsequent Endoscopic Postoperative Remission in Crohn’s Disease. Dig Dis Sci 66, 4429–4435 (2021).

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