C-Reactive Protein, Fecal Calprotectin, and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis.

Abstract

OBJECTIVES:

Persistent disease activity is associated with a poor prognosis in inflammatory bowel disease (IBD). Therefore, monitoring of patients with intent to suppress subclinical inflammation has emerged as a treatment concept. As endoscopic monitoring is invasive and resource intensive, identification of valid markers of disease activity is a priority. The objective was to evaluate the diagnostic accuracy of C-reactive protein (CRP), fecal calprotectin (FC), and stool lactoferrin (SL) for assessment of endoscopically defined disease activity in IBD.

METHODS:

Databases were searched from inception to November 6, 2014 for relevant cohort and case-control studies that evaluated the diagnostic accuracy of CRP, FC, or SL and used endoscopy as a gold standard in patients with symptoms consistent with active IBD. Sensitivities and specificities were pooled to generate operating property estimates for each test using a bivariate diagnostic meta-analysis.

RESULTS:

Nineteen studies (n=2499 patients) were eligible. The pooled sensitivity and specificity estimates for CRP, FC, and SL were 0.49 (95% confidence interval (CI) 0.34-0.64) and 0.92 (95% CI 0.72-0.96), 0.88 (95% CI 0.84-0.90) and 0.73 (95% CI 0.66-0.79), and 0.82 (95% CI 0.73-0.88) and 0.79 (95% CI 0.62-0.89), respectively. FC was more sensitive than CRP in both diseases and was more sensitive in ulcerative colitis than Crohn's disease.

CONCLUSIONS:

Although CRP, FC, and SL are useful biomarkers, their value in managing individual patients must be considered in specific clinical contexts.

• Authors: Mahmoud H Mosli, Guangyong Zou, Sushil K Garg, Sean G Feagan, John K MacDonald, Nilesh Chande, William J Sandborn, Brian G Feagan
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 110 Issue 6 Pg. 802-19; quiz 820 (Jun 2015) ISSN: 1572-0241 [Electronic] United States
• PMID: 25964225 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Biomarkers
• Leukocyte L1 Antigen Complex
• C-Reactive Protein
• Lactoferrin

Topics

• Biomarkers (metabolism)
• C-Reactive Protein (metabolism)
• Colitis, Ulcerative (diagnosis)
• Crohn Disease (diagnosis)
• Endoscopy, Gastrointestinal
• Feces (chemistry)
• Humans
• Lactoferrin (metabolism)
• Leukocyte L1 Antigen Complex (metabolism)
• Sensitivity and Specificity