Association of Faecal Calprotectin Level and Combined Endoscopic and Radiological Healing in Patients With Crohn’s Disease Receiving Anti-tumour Necrosis Factor Therapy
Soo Min Noh, Eun Hye Oh, Seong Ho Park, Jung Bok Lee, Jin Yong Kim, Jae Cheol Park, Jeongseok Kim, Nam Seok Ham, Sung Wook Hwang, Sang Hyoung Park, Dong‐Hoon Yang, Jeong‐Sik Byeon, Seung‐Jae Myung, Suk‐Kyun Yang, Beyong Duk Ye
Abstract
BACKGROUND AND AIMS: Combined endoscopic and radiological healing, or deep healing, is associated with favourable outcomes in patients with Crohn's disease; thus, a non-invasive biomarker for predicting deep healing would be invaluable. We evaluated the usefulness of faecal calprotectin for predicting deep healing in patients with Crohn's disease receiving anti-tumour necrosis factor [TNF] therapy. METHODS: We analysed the records of patients with Crohn's disease who received anti-tumour necrosis factor therapy and underwent endoscopic evaluation, radiological evaluation, and faecal calprotectin measurement within a period of 3 months between August 2017 and November 2018. Results of endoscopic and radiological studies were independently reviewed by two gastrointestinal endoscopists and a gastrointestinal radiologist, respectively. Serum C-reactive protein and albumin were also measured. RESULTS: Out of 268 patients analysed, 77 [28.7%] had deep healing, 36 [13.4%] had endoscopic healing only, 36 [13.4%] had radiological healing only, and 119 [44.4%] had neither. The median duration of anti-TNF treatment was 40.0 months. The deep healing group had the lowest median faecal calprotectin level [56.5 mg/kg] among the four groups [p <0.001]. The faecal calprotectin cutoff level of 81.1 mg/kg showed a sensitivity of 0.623 and a specificity of 0.817 in predicting deep healing (area under the receiver operating characteristic curve [AUROC], 0.767; 95% confidence interval, 0.702-0.832). Adding serum C-reactive protein and serum albumin to faecal calprotectin further increased the AUROC to 0.805 [95% confidence interval, 0.752-0.858]. CONCLUSIONS: Faecal calprotectin, when combined with serum C-reactive protein and albumin, showed acceptable performance in predicting deep healing in patients with Crohn's disease.