The Correlation Between a Fecal Calprotectin and a a Clinical Index for Disease Activity for Crohnʼs Disease: A Prospective Cohort

Introduction: The optimal way to follow a patient with Crohn's disease in routine clinical care is unknown as routine endoscopy for mucosal healing is not practical. Current approaches include clinical scoring systems for Crohn's Disease activity, such as the Harvey Bradshaw Index (HBI). Alternatively fecal calprotectin (FC) has been shown to correlate closely with endoscopic disease activity. In this study, we aimed to evaluate the correlation between FC, and HBI. These values were subsequently compared to disease activity as reported on CT enterography (CTE). Methods: A total of 103 patients were recruited from the ambulatory setting at St. Paul's Hospital, Vancouver, BC for a CTE evaluating Crohn's disease activity, between September 2012 and September 2014. They were enrolled in a larger study evaluating FC and disease activity evident on CTE. The inclusion criteria were: 1) patients were older than 19. 2) with a confirmed diagnosis of Crohn's disease, and 3) both HBI and FC data were avialable from the same office visit. Demographics, historic data, FC, HBI, and CTE findings were collected prospectively for further analysis. Results: Of 103 patients, 46% were male with average age of 43.6 +/- 15.7 years. Using a Spearman's correlation coefficient graph, no significant correlation was found between HBI and FC levels (rs = - 0.070 (p = 0.484, .95 CI, -0.2664, 0.1319)). Average HBI was 4.4 +/- 4.5 for active disease and 5.3 +/- 4.9 for inactive diasease, showing a statistically non-significant difference between the 2 groups (p=0.28). Average FC was 556 +/- 596.8 for νg/g for active disease and 181.6 +/- 222.3 for inactive disease (p=0.001). In order to assess the validity of FC against CTE findings, any value greater than 150 νg/g was considered to represent active disease. Using this cutoff, FC had a sensitivty of 0.61, specificty of 0.79, PPV of 0.76, and a NPV of 0.62 for detecting active disease, as defined by CTE. Conclusion: In this prospective study of patients with Crohn's disease, no significant correlation was found between FC, an objective biomarker of disease activity, and a clinical index of disease activity, HBI, as evident by cross-referencing them with the findings of CT enterography. Although questionnaires such as HBI may not be completely reliable to assess Crohn's disease acitivity, further research is needed to confirm the utility of FC as a more objective measure of Crohn's disease activity than indices such as HBI.Figure 1Figure 2

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