Fecal Calprotectin Levels Predict Histological Healing in Ulcerative Colitis
Bibliographic record
Abstract
Introduction: Mucosal healing as measured by endoscopic activity is the therapeutic target for ulcerative colitis (UC) and associated with improved outcomes. The moderate accuracy of fecal calprotectin (FC) at predicting macroscopic healing renders its utility as adjunctive and not substitutive of a colonoscopy. This discrepancy may be better explained by examining the association between FC and histologic activity. We investigated the clinical utility of FC levels to predict depth of remission including histological healing in patients with UC. Methods: We performed a retrospective chart review of UC patients who underwent a full colonoscopy and had FC measured within 6 weeks prior to colonoscopy at a tertiary care IBD Center. Clinical, endoscopic, and histologic disease activity was assessed by Patient Reported Outcomes (PRO2), Mayo Endoscopic Score (0-3), and Nancy score (0-4), respectively. Outcomes of interest included 1) Deep remission (PRO2 remission and Mayo score 0) 2) deeper remission (deep remission plus Nancy score 0 or 1). Montreal classification defined disease extent (E1/E2/E3). FC levels were expressed in μg/g, compared using Mann-Whitney U and Kruskal-Wallis tests. AUCROC curve analysis was used to evaluate accuracy of the predictive values. Results: In 68 patients (median age 24 years), 35% had proctitis (E1), 19% left-sided (E2), and 46% pancolitis (E3). Increasing FC levels significantly correlated with disease extent (p=.006), Mayo score (p=.001) and Nancy scores (p<.001). FC levels were lower in Mayo 0 compared to Mayo 1, 2, and 3 (40 vs. 267, 429, and, 857; p<.001). FC levels were similar in Nancy 0 and 1 (10 vs. 21, p >.05) and significantly lower in Nancy 0/1 compared to Nancy 2, 3, and 4 (359, 259 and 695, respectively, p <.001). Patients with Mayo 0/1 and Nancy score ≤ 1 (n=20) had significantly lower FC levels compared to those with Mayo 0/1 and Nancy ≥ 2 (31 vs. 231 p <.001). FC level of 60 predicted deep remission (AUC = 0.92, sensitivity 86%, specificity 87% PPV 86%, NPV 87%), and deeper remission (AUC: 0.91, sensitivity 83% and specificity 90 % PPV 83%, NPV 98%). Conclusion: FC levels significantly correlated with endoscopic extent, mucosal and histologic activity, and reflect microscopic disease activity even in the face of macroscopic healing. An FC level of ≤ 60 μg/g robustly predicted depth of remission suggesting that FC can be used instead of colonoscopy in a treat to target paradigm in patients with UC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".