Faecal calprotectin as a non-invasive marker of Crohn's disease in anal fistulas

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-02-14 DOI:10.1111/codi.70026

Helene Perregaard, Freja Pust, Andreas Nordholm-Carstensen

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Abstract

Aim

Faecal calprotectin (FC) is a noninvasive marker that reflects intestinal inflammation with good sensitivity. A prior study indicated that FC values above 150 μg/g could distinguish between anal fistulas (AF) of cryptoglandular or Crohn's disease (CD) origin. It is hypothesized as a useful triage test to rule out CD in newly referred AF patients, thus reducing the number of ileocolonoscopies performed and optimizing treatment regimens in AF while minimizing patient discomfort as well as healthcare costs. The aim of the study was to determine the accuracy of FC in distinguishing between anal fistulas of cryptoglandular and CD origin, as well as compare characteristics in fistulas.

Method

Patients referred with anal fistula who had an FC measurement and either ileocolonoscopy or colonoscopy within 12 weeks were included. Demographic and clinical characteristics were registered. Area under the curve (AUC) was calculated as well as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy.

Results

A total of 63 patients were included (CD n = 31, 49%). FC was significantly higher in CD compared to cryptoglandular fistulas, even when CD was medically treated or had no luminal activity on endoscopy. FC ≥110 μg/g was significantly associated with CD (OR 12.5; 95% CI: 3.77–41.4) p < 0.0001. This was found by plotting a receiver operating characteristic (ROC) curve, with AUC 80.8 (95% CI: 0.6952–0.9217). Sensitivity and specificity were 0.76 and 0.80, respectively (PPV 76%, NPV 80% and accuracy 78%).

Conclusion

FC discriminates CD from cryptoglandular fistulas, even in medically treated CD with normal endoscopic findings.

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粪钙保护蛋白作为肛门瘘中克罗恩病的非侵入性标志物

目的粪钙保护蛋白（FC）是反映肠道炎症的无创标志物，具有良好的敏感性。先前的一项研究表明，FC值高于150 μg/g可以区分隐腺性肛瘘（AF）或克罗恩病（CD）。假设它是一种有用的分诊试验，可以在新转诊的房颤患者中排除CD，从而减少进行回肠结肠镜检查的次数，优化房颤的治疗方案，同时最大限度地减少患者的不适和医疗费用。本研究的目的是确定FC区分隐腺性肛瘘和CD性肛瘘的准确性，并比较瘘管的特征。方法纳入12周内行FC测量和回肠结肠镜检查或结肠镜检查的肛瘘患者。登记人口学和临床特征。计算曲线下面积（AUC）、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和总体准确率。结果共纳入63例患者（CD = 31, 49%）。与隐腺瘘相比，CD中的FC明显更高，即使在CD接受药物治疗或内窥镜检查没有腔内活动时也是如此。FC≥110 μg/g与CD显著相关(OR 12.5；95% CI: 3.77-41.4) p < 0.0001。通过绘制受试者工作特征（ROC）曲线发现，AUC为80.8 （95% CI: 0.6952-0.9217）。灵敏度和特异性分别为0.76和0.80 （PPV 76%, NPV 80%，准确率78%）。结论FC可区分CD和隐腺瘘，即使是经药物治疗的CD，内窥镜检查结果正常。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.