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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparison of fecal calprotectin levels and endoscopic scores for predicting relapse in patients with ulcerative colitis in remission
Natsuki Ishida, Tatsuhiro Ito, Kenichi Takahashi, Yusuke Asai, Takahiro Miyazu, Tomohiro Higuchi, Satoshi Tamura, Shinya Tani, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Satoshi Osawa, Ken Sugimoto
Natsuki Ishida, Tomohiro Higuchi, Satoshi Osawa, Department of Endoscopic and Photodynamic Medicine, Hamamatsu University of School of Medicine, Hamamatsu 431-3192, Japan
Tatsuhiro Ito, Kenichi Takahashi, Yusuke Asai, Takahiro Miyazu, Satoshi Tamura, Shinya Tani, Mihoko Yamade, Yasushi Hamaya, Ken Sugimoto, First Department of Medicine, Hamamatsu University of School of Medicine, Hamamatsu 431-3192, Japan
Moriya Iwaizumi, Department of Laboratory Medicine, Hamamatsu University of School of Medicine, Hamamatsu 431-3192, Japan
Author contributions: Ishida N made the concept of this study; Ishida N and Sugimoto K designed the study; Ishida N, Ito T, Takahashi K, Asai Y, Miyazu T, Higuchi T, Tamura S and Tani S collected the data; Yamade M, Iwaizumi M, and Hamaya Y analyzed the data; Ishida N and Sugimoto K wrote the article; and Hamaya Y and Osawa S provided critical insights regarding article preparation.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: Informed consent from patients was obtained in the form of an opt-out form on the hospital website.
Conflict-of-interest statement: The authors have no conflicts of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ken Sugimoto, MD, PhD, Professor, First Department of Medicine, Hamamatsu University of School of Medicine, No. 1-20-1 Handayama, Hamamatsu 431-3192, Japan. sugimken@hama-med.ac.jp
Received: June 10, 2023
Peer-review started: June 10, 2023
First decision: August 8, 2023
Revised: August 24, 2023
Accepted: November 29, 2023
Article in press: November 29, 2023
Published online: December 21, 2023
BACKGROUND
Although the usefulness of endoscopic scores, such as the Mayo Endoscopic Subscore (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and Ulcerative Colitis Colonoscopic Index of Severity (UCCIS), and biomarkers such as fecal calprotectin (FC) for predicting relapse in ulcerative colitis (UC) has been reported, few studies have included endoscopic scores for evaluating the entire colon.
AIM
To compare the usefulness of FC value and MES, UCEIS, and UCCIS for predicting relapse in patients with UC in clinical remission.
METHODS
In total, 75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled. The diagnosis of UC was confirmed based on the clinical presentation, endoscopic findings, and histology, according to the current established criteria for UC. Fecal samples were collected the day before or after the colonoscopy for measurement of FC. Endoscopic evaluations were performed using MES, UCEIS, and UCCIS. The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES, UCEIS, UCCIS, and FC. The secondary outcome was the comparison between endoscopic scores and biomarkers in enrolled patients with UC with mucosal healing.
RESULTS
FC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively). Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve of UCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patients experienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of the remission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The area under the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significant difference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was 86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES.
CONCLUSION
The three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEIS may be the most useful in terms of ease of evaluation and accuracy.
Core Tip: We evaluated the usefulness of fecal calprotectin and endoscopic scores, including the Mayo Endoscopic Subscore, Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and Ulcerative Colitis Colonoscopic Index of Severity, in patients with ulcerative colitis (UC) in remission. All three endoscopic scores and fecal calprotectin are useful for predicting relapse in UC. The UCEIS is easy to evaluate and appears to be highly accurate in predicting relapse.
