Euroasian journal of hepato-gastroenterology

Register      Login

VOLUME 6 , ISSUE 2 ( July-December, 2016 ) > List of Articles


Fecal Calprotectin for predicting Relapse and Activity in Patients with Crohn’s Disease: A Meta-analysis

Ying Zhuge, Qiu-Ping Huang, Qing Li, Jun-Shan Wang

Citation Information : Zhuge Y, Huang Q, Li Q, Wang J. Fecal Calprotectin for predicting Relapse and Activity in Patients with Crohn’s Disease: A Meta-analysis. Euroasian J Hepatogastroenterol 2016; 6 (2):116-124.

DOI: 10.5005/jp-journals-10018-1182

License: CC BY-NC 4.0

Published Online: 01-05-2010

Copyright Statement:  Copyright © 2016; The Author(s).


Aims: We aimed to perform a meta-analysis of the predictive capacity of fecal calprotectin (FC) in activity and relapse of Crohn’s disease (CD). Materials and methods: MEDLINE, EMBASE, and the Cochrane Library databases were searched systematically. Pooled sensitivity, specificity, and other diagnostic indices were evaluated. Results: A total of 1,252 CD patients from 18 different studies were analyzed. The pooled sensitivity and specificity of FC at a cutoff value of 50 μg/g to predict activity of CD were 0.91 [95% confidence interval (CI): 0.87–0.95] and 0.47 (95% CI: 0.35–0.59) respectively. The pooled sensitivity and specificity of FC at a cutoff value of larger than 150 μg/g to monitor relapse of CD was 0.75 (95% CI: 0.67–0.82) and 0.71 (95% CI: 0.66–0.76) respectively. The area under the summary receiver operating characteristic (SROC) curve of FC for detecting CD activity was 0.78 (50 μg/g), 0.88 (100 μg/g), 0.85 (>150 μg/g), and the diagnostic odds ratio (DOR) was 10.21 (50 μg/g), 10.20 (100 μg/g), 11.68 (>150 μg/g) respectively. Conclusion: As a simple and noninvasive marker, FC is useful to predict the activity and relapse in CD patients, and the capacity of FC to predict CD activity was superior to its application in monitoring relapse of CD.

PDF Share
  1. Wolf DC, Abraham BP, Afzali A, Allegretti PD, Arai R. Community perspectives: combining serology, genetics, and inflammation markers for the diagnosis of IBD and differentiation between CD and UC. Gastroenterol Hepatol (NY) 2012 Jun;8(6 Suppl 2):1-16
  2. Tumor necrosis factor-alpha antibodies (infliximab, adalimumab and certolizumab) in Crohn’s disease: systematic review and meta-analysis. Arch Med Sci 2013 Oct;9(5):765-779
  3. A systematic review and economic evaluation of the use of tumour necrosis factoralpha (TNF-alpha) inhibitors, adalimumab and infliximab, for Crohn’s disease. Health Technol Assess 2011 Feb;15(6): 1-244
  4. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 2007 Aug;133(2):412-422
  5. Fecal calprotectin correlates more closely with the Simple Endoscopic Score for Crohn’s disease (SES-CD) than CRP, blood leukocytes, and the CDAI. Am J Gastroenterol 2010;105(1):162-169
  6. Serum ficolin-2 correlates worse than fecal calprotectin and CRP with endoscopic Crohn’s disease activity. J Crohn’s Colitis 2014 Sep;8(9): 1125-1132
  7. Serum adalimumab concentration and clinical remission in patients with Crohn’s disease. Inflamm Bowel Dis 2013 May;19(6):1112-1122
  8. A prospective cohort study to determine the relationship between serum infliximab concentration and efficacy in patients with luminal Crohn’s disease. Aliment Pharmacol Ther 2014 May;39:1126-1135
  9. Relationship between serum infliximab trough levels and endoscopic activities in patients with Crohn’s disease under scheduled maintenance treatment. J Gastroenterol 2014 Apr;49(4):674-682
  10. Fecal calprotectin, lactoferrin, and endoscopic disease activity in monitoring anti-TNF-alpha therapy for Crohn’s disease. Inflamm Bowel Dis 2008 Oct;14(10): 1392-1398
  11. Capsule endoscopic findings correlate with fecal calprotectin and C-reactive protein in patients with suspected small-bowel Crohn’s disease. Scand J Gastroenterol 2014 Sep;49(9):1084-1090
  12. A prospective evaluation of the predictive value of faecal calprotectin in quiescent Crohn’s disease. J Crohns Colitis 2014 Sep;8(9):1022-1029
  13. Association between disease duration and usefulness of fecal calprotectin measurement in patients with Crohn’s disease. Pol Arch Med Wewn 2014;124(1-2):51-57
  14. Fecal calprotectin one year after ileocaecal resection for Crohn’s disease – a comparison with findings at ileocolonoscopy. J Crohns Colitis 2014 Aug;8(8):789-795
  15. Evaluation of Crohn’s disease activity: initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin. Eur Radiol 2014 Feb;24(2): 277-287
  16. Collaboration and John Wiley; 2011. Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. Available from: www.
  17. ; Gatsonis, C.; Deeks, J.J. Chapter 10: analysing and presenting results. In: Deeks, J.J.; Bossuyt, P.M.; Gatsonis, C., editors. Cochrane handbook for systematic reviews of diagnostic test accuracy version 1.0. The Cochrane Collaboration; 2010
  18. Is magnetic resonance imaging a reliable diagnostic tool in the evaluation of active Crohn’s disease in the small bowel? J Clin Gastroenterol 2013 Apr;47(4):328-338
  19. Measuring inconsistency in meta-analyses. BMJ 2003 Sep;327(7414): 557-560
  20. Faecal calprotectin and lactoferrin as markers for monitoring disease activity and predicting clinical recurrence in patients with Crohn’s disease after ileocolonic resection: a prospective pilot study. United European Gastroenterol J 2013 Oct;1(5):368-374
  21. Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMNelastase, CRP, and clinical indices. Am J Gastroenterol 2008;103:162-169
  22. Crohn’s disease activity assessed by fecal calprotectin and lactoferrin: correlation with Crohn’s disease activity index and endoscopic findings. Inflamm Bowel Dis 2008 Jan;14(1):40-46
  23. Surrogate markers and clinical indices, alone or combined, as indicators for endoscopic remission in anti-TNF-treated luminal Crohn’s disease. Scand J Gastroenterol 2012 May;47(5):528-537. Ying Zhuge et al 124 24. D’Haens G, Ferrante M, Vermeire S, Baert F, Noman M, Moortgat L, Geens P, Iwens D, Aerden I, Van Assche G, et al. Fecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease. Inflamm Bowel Dis 2012 Dec;18(12):2218-2224
  24. Neopterin is a novel reliable fecal marker as accurate as calprotectin for predicting endoscopic disease activity in patients with inflammatory bowel diseases. Inflamm Bowel Dis 2013 Apr;19(5):1043-1052
  25. A new rapid test for fecal calprotectin predicts endoscopic remission and postoperative recurrence in Crohn’s disease. J Crohns Colitis 2013 Dec;7(12):e641-651
  26. Fecal calprotectin is a predictive marker of relapse in Crohn’s disease involving the colon: a prospective study. Eur J Gastroenterol Hepatol 2009 Mar;22(3):340-345
  27. Does fecal calprotectin predict relapse in patients with Crohn’s disease and ulcerative colitis? J Crohns Colitis 2010 Jun;4(2):144-152
  28. Fecal calprotectin and lactoferrin for the prediction of inflammatory bowel disease relapse. Inflamm Bowel Dis 2009 Aug;15(8):1190-1198
  29. Can calprotectin predict relapse risk in inflammatory bowel disease? Am J Gastroenterol 2008 Aug;103(8):2007-2014
  30. Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn’s disease. Gut 2005 Mar;54(3):364-368
  31. Prediction of Crohn’s disease relapse with faecal calprotectin in infliximab responders: a prospective study. Aliment Pharmacol Ther 2011 Aug;34(4):462-469
  32. Faecal calprotectin assay after induction with anti-tumour necrosis factor alpha agents in inflammatory bowel disease: prediction of clinical response and mucosal healing at one year. Dig Liver Dis 2014 Nov;46(11):974-979
  33. Fecal calprotectin in predicting relapse of inflammatory bowel diseases: a meta-analysis of prospective studies. Inflamm Bowel Dis 2012 Oct;18(10):1894-1899
  34. Meta-analysis: fecal calprotectin for assessment of inflammatory bowel disease activity. Inflamm Bowel Dis 2014 Aug;20(8):1407-1415.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.