Suttichaimongkol Tanita, Coelho-Prabhu Nayantara, Bruining David H, Tariq Raseen, Snyder Melissa R, Loftus Edward V
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Inflamm Bowel Dis. 2024 Dec 5;30(12):2347-2355. doi: 10.1093/ibd/izae005.
Fecal calprotectin (FC) is a promising biomarker for assessing ulcerative colitis (UC) endoscopic activity. However, the optimal FC cutoff to identify each Mayo endoscopic subscore (MES) remains inconclusive.
The electronic medical records of 177 adult UC patients evaluated at Mayo Clinic Rochester from January 2017 to March 2023 were retrospectively reviewed, obtaining clinical data and US-based Werfen Diagnostics FC levels collected within 30 days before colonoscopy or flexible sigmoidoscopy. Three independent inflammatory bowel disease specialist endoscopists blindly reviewed the most severe endoscopic images for grading MES.
The median interval between FC collection and endoscopy was 2 days. Fecal calprotectin showed strong positive correlations with MES (Spearman's r = 0.709; P < .01) and other clinical parameters. Fecal calprotectin cutoff of 60 mcg/g effectively distinguished MES 0 from MES 1-3 (sensitivity, 0.78; specificity, 0.97; area under the receiver operating characteristic curve [AUC], 0.901) and predicted clinical remission (Total Mayo Score ≤2 and no subscore >1; sensitivity, 0.83; specificity, 0.98; AUC, 0.921). Fecal calprotectin cutoff of 110 mcg/g effectively differentiated MES 0-1 from MES 2-3 (sensitivity, 0.86; specificity, 0.87; AUC, 0.915), while a cutoff of 310 mcg/g distinguished MES 0-2 from MES 3 (sensitivity, 0.80; specificity, 0.76; AUC, 0.820).
This study supports the reliability and applicability of FC as a valuable marker of endoscopic inflammation, particularly in distinguishing MES 0 from MES 1-3 using the FC cutoff of 60 mcg/g. Sensitivity analysis demonstrated robust results.
粪便钙卫蛋白（FC）是评估溃疡性结肠炎（UC）内镜活动度的一种很有前景的生物标志物。然而，用于识别每个梅奥内镜亚评分（MES）的最佳FC临界值仍无定论。
回顾性分析2017年1月至2023年3月在罗切斯特梅奥诊所接受评估的177例成年UC患者的电子病历，获取临床数据以及结肠镜检查或乙状结肠镜检查前30天内收集的美国Werfen诊断公司检测的FC水平。三位独立的炎症性肠病专科内镜医师对最严重的内镜图像进行盲法评估以对MES进行分级。
FC采集与内镜检查之间的中位间隔时间为2天。粪便钙卫蛋白与MES（斯皮尔曼相关性系数r = 0.709；P < 0.01）及其他临床参数呈强正相关。FC临界值为60 mcg/g时可有效区分MES 0与MES 1 - 3（敏感性为0.78；特异性为0.97；受试者操作特征曲线下面积[AUC]为0.901），并预测临床缓解（总梅奥评分≤2且无亚评分>1；敏感性为0.83；特异性为0.98；AUC为0.921）。FC临界值为110 mcg/g时可有效区分MES 0 - 1与MES 2 - 3（敏感性为0.86；特异性为0.87；AUC为0.915），而临界值为310 mcg/g时可区分MES 0 - 2与MES 3（敏感性为0.80；特异性为0.76；AUC为0.820）。
本研究支持FC作为内镜炎症有价值标志物的可靠性和适用性，尤其是使用60 mcg/g的FC临界值区分MES 0与MES 1 - 3时。敏感性分析显示结果可靠。
