Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn's disease patients

作     者：Alice Jane Foster Matthew Smyth Alam Lakhani Benjamin Jung Rollin F Brant Kevan Jacobson 

作者机构：Division of GastroenterologyHepatology and NutritionBritish Columbia Children’s Hospital PediatricsB.C.Children’s Hospital Research Institute PediatricsBritish Columbia children’s HospitalUniversity of British Columbia Department of StatisticsUniversity of British Columbia Department of Cellular and Physiological SciencesFaculty of Medicine 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2019年第25卷第10期

页      面：1266-1277页

核心收录：

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

基　　金：an unrestricted grant from the Lutsky Foundation Abbvie pharmaceuticals provided initial funding to purchase the Buhlmann ELISA kits 

主　　题：Fecal calprotectin Disease relapse Biomarker Crohn’s disease Children 

摘      要：BACKGROUND Asymptomatic children with Crohn s disease(CD) require ongoing monitoring to ensure early recognition of a disease *** In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease *** In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn s Disease Activity Index, Creactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 *** 53 children were included and eighteen patients(34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median(interquartile range), relapse 723μg/g(283-1758) vs 244 μg/g(61-627), P = 0.02]. Fecal calprotectin levels 250μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo(area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).CONCLUSION Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.