The correlation between fecal calprotectin, simple clinical colitis activity index and biochemical markers in ulcerative colitis during high-dose steroid treatment

Abstract

Objective. Monitoring active ulcerative colitis (UC) is essential for making correct and timely treatment decisions. The current monitoring is based on symptom scores and biochemical markers, among which the role of fecal calprotectin (FC) is debated. The aims were to assess the development in FC during steroid treatment and to compare FC with symptom scores and biochemical markers. Material and methods. A prospective observational study, including 16 patients with active UC requiring high-dose steroid treatment. FC, C-reactive protein (CRP), leukocytes, hemoglobin, albumin, and simple clinical colitis activity index (SCCAI) were assessed before the initiation of treatment, as well as on days 2, 6, 13, and 27. The one-year follow-up data were retrospectively obtained. Results. All patients had significant decreasing levels of FC (–1014 mg/kg, p = 0.0061), CRP (–10 mmol/l, p = 0.0313), and SCCAI (–3, p = 0.0002) during the first 4 days. After 27 days, the FC had decreased to 216 mg/kg (p = 0.002). A significant correlation between the changes in CRP and SCCAI was found (r_s = 0.65, p = 0.03) but not between FC and CRP or SCCAI. Overall, significant correlations between absolute levels of FC, CRP, and SCCAI were found. Levels of FC on day 0 and day 4 were not predictive of sustained clinical remission at 1-year follow up. Conclusions. FC, CRP, and SCCAI seem to be reliable markers of treatment response during steroid treatment. High initial levels of FC and a subsequent rapid reduction during steroid treatment were identified. FC levels were not found to be predictive of disease prognosis after one year.

Key Words::

• disease monitoring
• fecal calprotectin
• inflammatory bowel disease
• ulcerative colitis

Acknowledgments

All of the authors have made significant contributions to the research described in this article. KT took part in the design, recruitment, data collection, and analysis and drafted the manuscript. MKK took part in the design, recruitment, and critical revision of the manuscript. IN took part in the design and critical revision of the manuscript. AM took part in the critical revision of the manuscript. All of the authors have read and approved the final draft. The authors would like to thank The Danish Crohn's and Colitis Association for the grant that made this study possible. The organization had no influence in designing or conducting the study. The authors would also like to thank American Journal Experts for editing the manuscript for the English language. Parts of the data provided in this study were presented at 8th Congress of ECCO, Vienna, 2013.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.