Role of Inflammatory Markers as Predictors of Clinical Activity and Endoscopic Severity in Crohn’s Disease
AbstractObjective: We aim to assess the role of inflammatory markers as predictors of clinical activity and endoscopic severity in Crohn’s disease (CD).Methods: Patients attending for colonoscopy with known or suspected CD were recruited. Clinical disease activity was recorded as per the Crohn’s Disease Activity Index (CDAI) and endoscopic activity was recorded using the simple endoscopic score (SES) for CD. Receiver operating characteristic analysis (ROC) determined the predictive value and optimal predictive thresholds for the inflammatory markers.Results: The folllowing parameters were significantly different between clinically active CD and CD in remission: SES, C-reactive protein (CRP), white blood cell count (WBC), neutrophil count, hemoglobin, platelet count, albumin and fecal calprotectin (FC). And the following parameters were significantly different between patients with mild (SES<7) and moderate to severe (SES≥7) endoscopic activity: CDAI, WBC, CRP, neutrophil count, albumin and FC. The cut-off value for CRP for the detection of moderate to severe endoscopic activity in CD patients was calculated as ≥11.5 mg/L using ROC analysis [Sensitivity: 70%, specificity: 100%, AUC: 0.790 (0.567-1.013), P=0.028] whereas this cut-off value was 487 µg/g for FC [Sensitivity: 70%, specificity: 90%, AUC: 0.805 (0.598-1.01), P=0.028]. All of the 6 patients with FC >487 µg/g and CRP>11.5 mg/L were found to have moderate to severe endoscopic activity.Conclusion: Increased concentrations of either CRP or FC are predictive of clinical and endoscopic disease activity.
Onal IK, Arhan M, Özin Y, Taş A, Sezer S, Tunç B, et al. Efficacy and Safety of Azathioprine Therapy in Turkish Patients with Inflammatory Bowel Disease: A Retrospective Long Term Follow Up Study. Turkiye Klinikleri J Med Sci 2011; 31: 568-74.
Loftus EV Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn's disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther 2002; 16: 51-60.
Thia K, Faubion WA Jr, Loftus EV Jr, Persson T, Persson A, Sandborn WJ. Short CDAI: development and validation of a shortened and simplified Crohn’s disease activity index. Inflamm Bowel Dis 2011; 17: 105-111.
Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med 1983; 362: 1383-95.
Peyrin-Biroulet L, Reinisch W, Colombel JF, Mantzaris GJ, Kornbluth A, Diamond R, et al. Clinical disease activity, C-reactive protein normalisation and mucosal healing in Crohn's disease in the SONIC trial. Gut 2014; 63: 88-95.
Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology 1976; 70: 439-44.
Daperno M, D'Haens G, Van Assche G, Baert F, Bulois P, Maunoury V, et al. Development and validation of a new, simplified endoscopic activity score for Crohn’s disease: the SES-CD. Gastrointest Endosc 2004; 60: 505-12.
Benitez JM, Meuwis MA, Reenaers C, Van Kemseke C, Meunier P, Louis E. Role of endoscopy, cross-sectional imaging and biomarkers in Crohn’s disease monitoring. Gut 2013; 62: 1806-16.
Schnitzler F, Fidder H, Ferrante M, Noman M, Arijs I, Van Assche G, et al. Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn's disease. Inflamm Bowel Dis 2009; 15: 1295-1301.
Rutgeerts P, Van Assche G, Sandborn WJ, Wolf DC, Geboes K, Colombel JF, et al. Adalimumab induces and maintains mucosal healing in patients with Crohn's disease: data from the EXTEND trial. Gastroenterology 2012; 142: 1102-11.
Louis E, Mary JY, Vernier-Massouille G, Grimaud JC, Bouhnik Y, Laharie D, et al. Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology 2012; 142: 63-70.
Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990; 99: 956-63.
Onal IK, Beyazit Y, Sener B, Savuk B, Ozer Etik D, Sayilir A, et al. The value of fecal calprotectin as a marker ofintestinal inflammation in patients with ulcerative colitis. Turk J Gastroenterol 2012; 23: 509-14.
Tibble JA, Sigthorsson G, Bridger S. Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology 2000; 119: 15-22.
D'Incà R, Dal Pont E, Di Leo V, Benazzato L, Martinato M, Lamboglia F, et al. Can calprotectin predict relapse risk in inflammatory bowel disease? Am J Gastroenterol 2008; 103: 2007-14.
Jürgens M, Mahachie John JM, Cleynen I, Schnitzler F, Fidder H, van Moerkercke W, et al. Levels of C-reactive protein are associated with response toinfliximab therapy in patients with Crohn's disease. Clin Gastroenterol Hepatol 2011; 9: 421-7.
Meuwis MA, Vernier-Massouille G, Grimaud JC, Bouhnik Y, Laharie D, Piver E, et al. Serum calprotectin as a biomarker for Crohn's disease. J Crohns Colitis 2013; 7: 678-83.
Consigny Y, Modigliani R, Colombel JF, Dupas JL, Lémann M, Mary JY; Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID). A simple biological score for predicting low risk of short-term relapse in Crohn's disease. Inflamm Bowel Dis 2006; 12: 551-7.
All opinions and reports within the articles that are published in the Gazi Medical Journal are the personal opinions of author(s). Gazi University, Editors and the publisher do not accept any responsibility for these articles. The journal is printed on acid-free paper.