Table of Contents
ISRN Gastroenterology
Volume 2013 (2013), Article ID 179024, 5 pages
http://dx.doi.org/10.1155/2013/179024
Clinical Study

Fecal Calprotectin and Clinical Disease Activity in Pediatric Ulcerative Colitis

1Children's Hospital, Helsinki University Central Hospital, P.O. Box 281, 00029 Helsinki, Finland
2Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, P.O. Box 3235, Jerusalem 91031, Israel

Received 5 January 2013; Accepted 29 January 2013

Academic Editors: A. Amedei, A. W. Mangel, J. M. Pajares, L. Rodrigo, A. A. te Velde, and A. Weimann

Copyright © 2013 Kaija-Leena Kolho and Dan Turner. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. To explore fecal calprotectin levels in pediatric ulcerative colitis (UC) in relation with the validated clinical activity index PUCAI. Methods. This study included all 37 children (median age 14 years) with UC who had calprotectin measured (PhiCal ELISA Test) by the time of PUCAI assessment at the Children's Hospital of Helsinki in a total of 62 visits. Calprotectin values <100 μg/g of stool were considered as normal. The best cut-off value of each measure to predict 3-month clinical outcome was derived by maximizing sensitivity and specificity. Results. In clinically active disease (PUCAI ≥ 10), calprotectin was elevated in 29/32 patients (91% sensitivity). When in clinical remission, 26% (8/30) of the children had normal calprotectin but 7 (23%) had an exceedingly high level (>1000 μg/g). The best cut-off value for calprotectin for predicting poor outcome was 800 μg/g (sensitivity 73%, specificity 72%; area under the ROC curve being 0.71 (95%CI 0.57–0.85)) and for the PUCAI best cut-off values >10 (sensitivity 62%, specificity 64%; area under the ROC curve 0.714 (95%CI 0.58–0.85)). Conclusion. The clinical relevance of somewhat elevated calprotectin during clinical remission in pediatric UC is not known and, until further evidence accumulates, does not indicate therapy escalation.