Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Kostas Athanasios
Dissertation committee:
Παπαθεοδωρίδης Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ,
Παπακωνσταντίνου Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Βλαχογιαννάκος Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μπάμιας Γεώργιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μανωλακόπουλος Σπήλιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Καραμανώλης Γεώργιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βεζάκης Αντώνιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Βιολογικοί δείκτες βλεννογονικής επούλωσης σε ασθενείς με ΙΦΝΕ, σε κλινική ύφεση υπό θεραπεία με αντί-ΤΝF παράγοντες
Translated title:
Surrogate markers for mucosal healing in IBD patients with clinical remission under treatment with anti-TNF agents
Summary:
AIM
To evaluate the utility of fecal calprotectin (FC) in predicting relapse and endoscopic activity during follow-up in an inflammatory bowel disease (IBD) cohort.
METHODS
All FC measurements that were obtained during a 3-year period from patients with inflammatory bowel disease in clinical remission were identified. Data regarding the short-term (6 mo.) course of the disease were extracted from the medical files. Exclusion criteria were defined as: An established flare of the disease at the time of FC measurement, Loss to follow up within 6 mo. from baseline FC measurement, and, Insufficient data on file. Statistical analysis was performed to evaluate whether baseline FC measurement could predict the short-term clinical relapse and/or the presence of mucosal healing.
RESULTS
We included 149 [Crohn’s disease (CD) = 113, Ulcerative colitis (UC) = 36, male = 77] IBD patients in our study. Within the determined 6-month period post-FC measurement, 47 (31.5%) had a disease flare. Among 76 patients who underwent endoscopy, 39 (51.3%) had mucosal healing. Baseline FC concentrations were significantly higher in those who had clinical relapse compared to those who remained in remission during follow up (481.0 μg/g, 286.0-600.0 vs 89.0, 36.0-180.8, P < 0.001). The significant predictive value of baseline median with IQR FC for clinical relapse was confirmed by multivariate Cox analysis [HR for 100μg/g: 1.75 (95%CI: 1.28-2.39), P = 0.001]. Furthermore, lower FC baseline values significantly correlated to the presence of mucosal healing in endoscopy (69.0 μg/g, 30.0-128.0 vs 481.0, 278.0-600.0, in those with mucosal inflammation, median with IQR, P < 0.001). We were able to extract cut-off values for FC concentration with a high sensitivity and specificity for predicting clinical relapse (261 μg/g with AUC = 0.901, sensitivity 87.2%, specificity 85.3%, P < 0.001) or mucosal healing (174 μg/g with AUC = 0.956, sensitivity 91.9%, specificity 87.2%, P < 0.001). FC was better than CRP in predicting either outcome; nevertheless, having a pathological CRP (> 5 mg/L) in addition to the cutoffs for FC, significantly enhanced the specificity for predicting clinical relapse (95.1% from 85.3%) or endoscopic activity (100% from 87.2%).
CONCLUSION
Serial FC measurements may be useful in monitoring IBD patients in remission, as FC appears to be a reliable predictor of short-term relapse and endoscopic activity.
Main subject category:
Health Sciences
Keywords:
Surrogate markers, IBD, Calprotectin
Number of references:
203
