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Utility of faecal calprotectin in inflammatory bowel disease (IBD) : what cut-offs should we apply?

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Dhaliwal, A., Zeino, Z., Tomkins, C., Cheung, M., Nwokolo, Chuka U., Smith, S., Harmston, Christopher and Arasaradnam, Ramesh P. (2014) Utility of faecal calprotectin in inflammatory bowel disease (IBD) : what cut-offs should we apply? Frontline Gastroenterology, Volume 6 (Number 1). pp. 14-19. doi:10.1136/flgastro-2013-100420

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Official URL: http://dx.doi.org/10.1136/flgastro-2013-100420

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Abstract

Abstract
Background Faecal calprotectin (FC), a cytosolic protein released by neutrophils (S100 family) in response to inflammation, is a simple, non-invasive test that can be used to differentiate irritable bowel syndrome (IBS) with inflammatory bowel disease (IBD), where there can be considerable symptom overlap.

Aims and methods The aims of the study were (1) to be able to predict the ability of FC to exclude IBD and determine cut-offs when in remission, (2) to investigate the effects of time and temperature on stability of FC and (3) compare three ELISA kits to measure FC: Buhlmann, PhiCal v1 and PhiCal v2. A total of 311 patients with altered bowel habit were tested for FC; 144 with IBS, 148 with IBD and 19 with other organic causes.

Results Sensitivity and specificity of FC (with PhiCal v2 kit) to distinguish between functional disorder (IBS) and IBD using cut-off 50 μg/g were 88% and 78%, respectively, with a negative predictive value of 87%. Area under the receiver operating curve was 0.84 (CI 0.78 to 0.90). For those with IBD, FC values below 250 μg/g corresponded with remission of disease with a sensitivity and specificity of 90% and 76%, respectively. Area under the receiver operating curve was 0.93 (CI 0.89 to 0.97). FC was stable once extracted and frozen for up to 2.5 months. Pearson correlation was good between Buhlmann assay and PhiCal v2 (r2 = 0.95).

Conclusions FC has up to 87% negative predictive value to exclude IBD, and cut-offs less than 250 μg/g had 90% sensitivity to determine remission in IBD. Once frozen, FC is stable and the ELISA monoclonal plates were broadly comparable.

Item Type: Journal Article
Subjects: Q Science > QP Physiology
R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Irritable colon -- Diagnosis
Journal or Publication Title: Frontline Gastroenterology
Publisher: BMJ Group
ISSN: 2041-4137
Official Date: 17 March 2014
Dates:
DateEvent
17 March 2014Available
26 February 2014Accepted
20 November 2013Submitted
Volume: Volume 6
Number: Number 1
Page Range: pp. 14-19
DOI: 10.1136/flgastro-2013-100420
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
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