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Low Levels of Fecal Calprotectin 3 Months After Surgery Predict Subsequent Endoscopic Postoperative Remission in Crohn’s Disease

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Abstract

Background/Aims

In Crohn’s disease (CD) few data are available on the usefulness of monitoring fecal calprotectin (FC) in the early postoperative setting. We assessed prospectively the accuracy of FC measured 3 months after surgery to predict the risk of endoscopic postoperative recurrence (POR) within 1 year after resection.

Methods

In 55 consecutive CD patients who had undergone ileocolonic resection samples were collected 3 months after surgery for measuring serum CRP and FC. Endoscopic POR was assessed by ileocolonoscopy within 6–12 months (median 7 months). Receiver operating characteristic (ROC) curves were generated to assess accuracy of the markers, to determine the best threshold and to calculate sensitivity, specificity, positive and negative predictive values.

Results

In contrast with median CRP levels, median FC concentrations measured 3 months after surgery were significantly higher in patients who later experienced endoscopic POR (Rutgeerts ≥ i2) compared with those who stayed in endoscopic remission within the following 6–12 months (205 μg/g IQR [106–721] vs. 103 μg/g IQR [60–219], p = 0.008). Area under the ROC curve for FC was 0.71. The best cutoff value of FC to identify patients in subsequent endoscopic remission 3 months after surgery was 65 μg/g (96% sensitivity, 31% specificity, 50% positive and 91% negative predictive values). In multivariate analysis, FC < 65 µg/g at 3 months was the only factor associated with subsequent endoscopic remission.

Conclusion

FC measured 3 months after surgery below 65 μg/g is an accurate marker to identify CD patients who will later stay in endoscopic remission within 1 year after resection.

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Abbreviations

FC:

Fecal calprotectin

hsCRP:

High sensitivity C-reactive protein

CD:

Crohn’s disease

ROC:

Receiver operating characteristic

AUROC:

Area under the ROC curve

IQR:

Interquartile range 25–75

OR:

Odds ratio

95% CI:

95% confidence interval

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Author notes

  1. Bernard Flourie and Stéphane Nancey have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Hospices Civils de Lyon, Lyon-Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Benite, France

    Florian Veyre, Gilles Boschetti, Camille Meunier, Claire Gay, Anne-Laure Charlois, Remi Duclaux-Loras, Pauline Danion, Bernard Flourie & Stéphane Nancey

  2. CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France

    Gilles Boschetti, Remi Duclaux-Loras, Mathias Faure, Bernard Flourie & Stéphane Nancey

  3. Laboratory of Biochemistry, Hospices Civils de Lyon, Lyon-Sud University Hospital, Pierre-Bénite, France

    Charlotte Cuerq & Anne Mialon

  4. Department of Surgery, Hospices Civils de Lyon, Lyon-Sud University Hospital, Pierre-Bénite, France

    Eddy Cotte & Vahan Kepenekian

  5. Department of Gastroenterology, EA-30 64, Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP), Faculty of Medicine of Saint-Etienne, Saint-Etienne University Hospital, Saint-Etienne, France

    Xavier Roblin

  6. Equipe Labellisée par la Fondation pour la Recherche Médicale, FRM, Montpellier, France

    Gilles Boschetti, Remi Duclaux-Loras, Mathias Faure, Bernard Flourie & Stéphane Nancey

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  1. Florian Veyre
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Contributions

Conception and design of the study: SN, GB, MF, XR, BF. Generation, collection, assembly, analysis and/or interpretation of data: drafting or revision of the manuscript: FV, GB, CM, CC, AC, RDL, PD, EC, VK, AM, MF, XR, BF, SN. Approval of the final version of the manuscript: FV, GB, CM, CC, AC, RDL, PD, EC, VK, AM, MF, XR, BF, SN. All the authors had access to all the study data and had reviewed and approved the present final manuscript.

Corresponding author

Correspondence to Stéphane Nancey.

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Veyre, F., Boschetti, G., Meunier, C. et al. Low Levels of Fecal Calprotectin 3 Months After Surgery Predict Subsequent Endoscopic Postoperative Remission in Crohn’s Disease. Dig Dis Sci 66, 4429–4435 (2021). https://doi.org/10.1007/s10620-020-06751-z

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  • DOI: https://doi.org/10.1007/s10620-020-06751-z

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