%0 Journal Article
%T Fecal Calprotectin and Clinical Disease Activity in Pediatric Ulcerative Colitis
%A Kaija-Leena Kolho
%A Dan Turner
%J ISRN Gastroenterology
%D 2013
%R 10.1155/2013/179024
%X Objective. To explore fecal calprotectin levels in pediatric ulcerative colitis (UC) in relation with the validated clinical activity index PUCAI. Methods. This study included all 37 children (median age 14 years) with UC who had calprotectin measured (PhiCal ELISA Test) by the time of PUCAI assessment at the Children's Hospital of Helsinki in a total of 62 visits. Calprotectin values <100ˋ米g/g of stool were considered as normal. The best cut-off value of each measure to predict 3-month clinical outcome was derived by maximizing sensitivity and specificity. Results. In clinically active disease (PUCAI ≡ 10), calprotectin was elevated in 29/32 patients (91% sensitivity). When in clinical remission, 26% (8/30) of the children had normal calprotectin but 7 (23%) had an exceedingly high level (>1000ˋ米g/g). The best cut-off value for calprotectin for predicting poor outcome was 800ˋ米g/g (sensitivity 73%, specificity 72%; area under the ROC curve being 0.71 (95%CI 0.57每0.85)) and for the PUCAI best cut-off values >10 (sensitivity 62%, specificity 64%; area under the ROC curve 0.714 (95%CI 0.58每0.85)). Conclusion. The clinical relevance of somewhat elevated calprotectin during clinical remission in pediatric UC is not known and, until further evidence accumulates, does not indicate therapy escalation. 1. Introduction Neutrophil-derived markers, such as fecal calprotectin or lactoferrin, have proven to correlate well with mucosal inflammation of ulcerative colitis (UC) at a rho range of 0.6每0.8 [1每4]. Fecal level of these markers reflects the mucosal influx of inflammatory cells in the gut. When the level of these markers is low, the presence of active inflammation in the colon is unlikely [3, 5每8]. The probability of 1-year remission in UC children with normal calprotectin may be as high as 75% [9]. On the other hand, in UC (and unlike in Crohn＊s disease), clinical judgment of symptoms also correlates well with endoscopic appearance, at a range of rho 0.7每0.8 [10], and clinical assessment also predicts well clinical outcomes in both adult [11] and pediatric severe UC [12]. Recently, we showed that calprotectin levels rarely decline completely during therapy with glucocorticoids or TNF-汐-antagonist agents suggesting ongoing inflammation in the majority [13, 14]. The PUCAI is the validated pediatric ulcerative colitis activity index showing good correlation with endoscopic disease activity [15每17]. The index is based on item scores reflecting the clinical situation within the last two days and may thus be used in the acute setting [15]. In acute severe colitis,
%U http://www.hindawi.com/journals/isrn.gastroenterology/2013/179024/