Fecal calprotectin as an alternative to ulcerative colitis endoscopic index of severity to predict the response to corticosteroids of acute severe ulcerative colitis: a prospective observational study

• Published in: Digestive and liver disease Vol. 49; no. 9; pp. 984 - 990
• Main Authors: Xie, Tingbin, Zhao, Chenyan, Ding, Chao, Zhang, Tenghui, Dai, Xujie, Lv, Tengfei, Li, Yi, Guo, Zhen, Gong, Jianfeng, Zhu, Weiming
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-09-2017
• Subjects: Acute Disease; Acute severe ulcerative colitis; Adrenal Cortex Hormones - therapeutic use; Adult; China; Colitis, Ulcerative - drug therapy; Disease Management; Fecal calprotectin; Feces - chemistry; Female; Gastroenterology and Hepatology; Humans; Inflammatory bowel diseases; Leukocyte L1 Antigen Complex - analysis; Male; Middle Aged; Multivariate Analysis; Prognosis; Prospective Studies; Risk Factors; ROC Curve; Severity of Illness Index; Sigmoidoscopy; Ulcerative colitis endoscopic index of severity; acute severe ulcerative colitis; inflammatory bowel diseases; fecal calprotectin; Ulcerative Colitis Endoscopic Index of Severity; Fecal calprotectin; Inflammatory bowel diseases; Ulcerative colitis endoscopic index of severity; Acute severe ulcerative colitis
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2017.04.021

Abstract Background Fecal calprotectin (FC) might be an alternative to ulcerative colitis endoscopic index of severity (UCEIS) to predict the response to corticosteroids (CS) in acute severe colitis (ASC). Methods One hundred and seventeen ASC patients were prospectively enrolled. Demographic, clinical, laboratory and sigmoidoscopic data were documented. Multivariate and ROC analyses were performed to identify risk factors for non-response to CS, and the predictive accuracy of possible predictors was assessed. Results Totally, 39 (33.33%) patients failed intravenous CS therapy. CS responders among mild (UCEIS 3-4), moderate (UCEIS 5-6) and severe (UCEIS 7-8) groups were 40/44 (90.91%) vs. 36/55 (65.45%) vs. 2/18 (11.11%) ( p < 0.001). UCEIS (OR = 5.08; 95% CI, 1.93-8.66) and FC (OR = 2.56; 95% CI, 1.17–3.55) were found to be independent risk factors for CS non-responders. Compared with C-reactive protein, platelet, hemoglobin and albumin, baseline FC had the strongest correlation with UCEIS ( r = 0.701, p<0.001). ROC analysis of UCEIS and baseline FC in predicting CS non-response showed an AUC of 0.85 and 0.76 respectively. Conclusions Baseline FC levels correlated significantly with UCEIS in ASC, and both were useful in predicting short-term outcome of CS treatment. Baseline FC levels could be used as an alternative of UCEIS to guide the decision of early salvage therapy or colectomy and reduce the adverse effects of long-term futile CS usage.