Ishida N, Ito T, Takahashi K, Asai Y, Miyazu T, Higuchi T, Tamura S, Tani S, Yamade M, Iwaizumi M, Hamaya Y, Osawa S, Sugimoto K. Comparison of fecal calprotectin levels and endoscopic scores for predicting relapse in patients with ulcerative colitis in remission. World J Gastroenterol 2023; 29(47): 6111-6121 [PMID: 38186681 DOI: 10.3748/wjg.v29.i47.6111]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
The goal of ulcerative colitis (UC) treatment is to achieve mucosal healing, for which endoscopic evaluation is recommended. To avoid endoscopy, fecal calprotectin (FC), which may be an alternative biomarker for UC, was reported to be useful in evaluating patients. Although endoscopic scores and FC, in addition to traditional biomarkers and the Mayo Endoscopic Subscore (MES), are useful for predicting relapse in patients with UC in remission, no studies have compared the predictive abilities of the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Ulcerative Colitis Colonoscopic Index of Severity (UCCIS), which assesses the entire colon.
Research motivation
To evaluate whether FC and MES, UCEIS, and UCCIS are useful for predicting relapse in patients with UC in clinical remission.
Research objectives
Overall, 75 patients with UC in clinical remission, with a clinical activity index (CAI) according to Rachmilewitz score was ≤ 4, underwent colonoscopic examination and FC measurements.
Research methods
We assessed whether the enrolled patients experienced UC relapse within 12 mo after endoscopic examination and FC measurement. Clinical relapse was defined as an increase in CAI above baseline due to worsening of diarrhea and abdominal pain or frequent or bloody stools, requiring modification or addition of treatment. We also evaluated the association between endoscopic scores and FC.
Research results
Cut-off values and areas under the curve (AUC) for FC and UCCIS in the receiver-operating characteristic analysis to predict clinical relapse were 323 mg/kg, 0.813 [95% confidence interval (CI)]: 0.698-0.927], and 10.2, for FC, AUC, and UCCIS, respectively.
The AUC was 0.823 (95%CI: 0.697-0.949). Univariate analysis was performed using these cut-off values (FC < 323 mg/kg vs ≥ 323 mg/kg; UCCIS < 10.2 vs ≥ 10.2; MES 0 vs 1; and UCEIS ≤ 1 vs ≥ 2). The accuracy of relapse prediction was the highest with UCCIS, followed by UCIES, FC, and MES.
Research conclusions
MES, UCEIS, UCCIS, and FC were useful for predicting relapse in patients with UC in clinical remission.
Research perspectives
UCCIS comprehensively evaluates the endoscopic activity of UC, helping to predict its relapse. However, its complexity poses a challenge. Among the three endoscopic scores, UCEIS may be the most useful in terms of ease of evaluation and accuracy.
