Disease monitoring in inflammatory bowel disease

Table 1 Endoscopic score correlation with C-reactive protein

Ref.	Disease	Endoscopic tool	Correlation	P value
Sipponen et al[88]	CD	CDEIS	r = 0.608	< 0.001
Schoepfer et al[77]	CD	CDEIS	r = 0.75	< 0.010
af Björkesten et al[25]	CD	SES-CD	r = 0.56	< 0.001
Lobatón et al[48]	UC	Mayo	r = 0.307	< 0.001

CDEIS: Crohn’s disease endoscopic index of severity; SES-CD: Simple endoscopic score for Crohn’s disease; r: Spearman’s rank correlation coefficient.

Table 2 C-reactive protein values and correlating endoscopic scores

Ref.	Disease	Endoscopic tool	Endoscopic score (descriptor)	Calculation	CRP scores
Falvey et al[71]	CD	SES-CD	0-2 (inactive)	Mean (95%CI)	2.9 mg/L (1.8-4.6)
			3-6 (mild)		4.0 mg/L (2.6-6.1)
			7-15 (moderate)		5.1 mg/L (3.0-9.0)
			> 16 (severe)		22 mg/L (12.5-38.9)
Sipponen et al[88]	CD	CDEIS	< 3 (inactive)	Median (95%CI)	0.0 mg/L (0-21)
			3-9 (mild)		0.0 mg/L (0-26)
			9-12 (moderate)		8.5 mg/L (0-85)
			≥ 12 (severe)		16.5 mg/L (0-211)
Schoepfer et al[77]	CD	SES-CD	0-3 (inactive)	Mean (range)	12 mg/L (3-94)
			4-10 (mild)		8 mg/L (3-53)
			11-19 (moderate)		23 mg/L (3-172)
			≥ 20 (high)		40 mg/L (5-121)

CDEIS: Crohn’s disease endoscopic index of severity; SES-CD: Simple endoscopic score for Crohn’s disease.

Table 3 Endoscopic score correlation with fecal calprotectin

Ref.	Disease	Endoscopic tool	Correlation	P value
af Björkesten et al[25]	CD	SES-CD	r = 0.560	< 0.001
Sipponen et al[88]	CD	CDEIS	r = 0.831	< 0.001
Sipponen et al[49]	CD	SES-CD	r = 0.642	< 0.001
Sipponen et al[62]	CD	CDEIS	r = 0.729	< 0.001
Schoepfer et al[77]	CD	SES-CD	r = 0.530	< 0.010
Lobatón et al[74]	CD	CDEIS	r = 0.7221	< 0.001
			r = 0.7692	< 0.001
Lobatón et al[48]	UC	Mayo	r = 0.7411	< 0.001
			r = 0.7272	< 0.001
Takashima et al[67]	UC	Mayo	r = 0.580	< 0.0001
Røseth et al[66]	UC	Mayo	r = 0.570	< 0.0001
D’Haens et al[64]	UC	Mayo	r = 0.623	< 0.001
	CD	CDEIS	r = 0.419	< 0.001
	CD	SES-CD	r = 0.490	< 0.001

¹FC-ELISA;

²FC Q-POCT (quantitative-point-of-care test). CDEIS: Crohn’s disease endoscopic index of severity; SES-CD: Simple endoscopic score for Crohn’s disease; r: Spearman’s rank correlation coefficient.

Table 4 Fecal calprotectin values and correlating endoscopic scores

Ref.	Disease	Endoscopic tool	Endoscopic score (descriptor)	Calculation	Calprotectin scores
Falvey et al[71]	CD	SES-CD	0-2 (inactive)	mean (95%CI)	55 μg/g (25-123)
			3-6 (mild)		167 μg/g (97-288)
			7-15 (moderate)		366 μg/g (192-698)
			16+ (severe)		732 μg/g (338-1587)
Sipponen et al[49]	CD	SES-CD	≤ 3 (inactive-mild)	Median (range)	37 μg/g (13-166)
			> 3 (active)		686 μg/g (18-15326)
Sipponen et al[62]	CD	CDEIS	< 3 (inactive)	Median (range)	63 μg/g (11-869)
			3-9 (mild)		170 μg/g (17-2440)
			9-12 (moderate)		1014 μg/g (123-2284)
			> 12 (severe)		2066 μg/g (323-18575)
Schoepfer et al[77]	CD	SES-CD	0-3 (inactive)	mean (range)	104 μg/g (10-725)
			4-10 (mild)		231 μg/g (12-1009)
			11-19 (moderate)		395 μg/g (68-912)
			≥ 20 (high)		718 μg/g (93-1327)
Lobatón et al[48]	CD	CDEIS	< 3 (endoscopic remission)	Median (range)	101.8 μg/g (30-1620.9)
			≥ 3 (endoscopic activity)		1211.9 μg/g (122-1800)

CDEIS: Crohn’s disease endoscopic index of severity; SES-CD: Simple endoscopic score for Crohn’s disease.

Table 5 Calprotectin cutoffs for predicting clinical relapse

Ref.	Disease	FC value	Relative risk	Sensitivity (%)	Specificity (%)
García-Sánchez et al[107]	UC	> 120 μg/g	6	80	60
	CD	> 200 μg/g	4
Tibble et al[108]	UC/CD	> 50 μg/g	13	90	83
Kallel et al[109]	CD	> 340 μg/g	18	80	90.7
Naismith et al[82]	CD	≥ 240 μg/g	12.18	80	74.4
Costa et al[110]	UC	> 150 μg/g	14	89	92
	CD	> 150 μg/g	2	87	43
D’Inca et al[103]	UC/CD	> 130 mg/kg	-	68	67

FC: Fecal calprotectin.

Table 6 Calculated fecal calprotectin cutoffs based on endoscopic score

Ref.	Disease	Endoscopic tool	Score	FC cutoff	Sensitivity(%)	Specificity(%)	PPV(%)	NPV(%)
Guidi et al[111]	UC/CD	CDEIS	< 3 (mucosal healing)	121 μg/ga	79	57	-	-
D’Haens et al[64]	CD	CDEIS	< 3 (inactive)	250 μg/g	94.1	62.2	48.5	96.6
	UC	Mayo	1-3 (any inflammation)	250 μg/g	71	100	100	47.1
Sipponen et al[88]	CD	CDEIS	≥ 3 (active)	200 μg/g	87	100	100	70
af Björkesten et al[25]	CD	SES-CD	0 (inactive)	94 μg/g	82	78	-	-
Lobatón et al[48]	UC	Mayo	0-1 (inactive-mild)1	250 μg/g1b	73.5	89.7	86.2	79.5
			0-1 (inactive-mild)2	280 μg/g2b	75.4	89.1	86	80.3
Takashima et al[67]	UC	Mayo	0 (inactive)	250 μg/g	82	62	61	83

¹FC-ELISA;

²FC-POCT;

^aP = 0.038;

^bP < 0.001 vs control. CDEIS: Crohn’s disease endoscopic index of severity; SES-CD: Simple endoscopic score for Crohn’s disease; FC: Fecal calprotectin.

Table 7 Predicting postoperative recurrence with fecal calprotectin

Ref.	Type of recurrence	Follow-up time	FC value	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
Lasson et al[98]	Endoscopic	1 yr	100 μg/g	85	35	50	75
			200 μg/g	54	53	47	60
			250 μg/g	46	53	43	56
Wright et al[96]	Endoscopic	6 mo	135 μg/g	91	62	55	93
		18 mo	127 μg/g	88	67	58	91
Orlando et al[94]	Endoscopic	1 yr	200 mg/L	63	75
Yamamoto et al[51]	Endoscopic	1 yr	140 μg/g	70	70	70	70
	Clinical		170 μg/g	83	93	83	93
Lobatón et al[74]	Endoscopic	Not specified	203 μg/g1	75	72	-	-
			283 μg/g2	67	72
Boschetti et al[44]	Endoscopic	Within 18 mo	100 μg/g	95	54	93	77

¹FC-ELISA test;

²FC Q-POCT (quantitative-point-of-care test). FC: Fecal calprotectin.