[A prospective multicenter study was conducted by Gisbert et al. (2009) to determine the role of fecal calprotectin and lactoferrin in the prediction of inflammatory bowel disease relapses. A total of 163 patients with ulcerative colitis (UC) (n=74) and Crohn's disease (CD) (n=89) who had been in clinical remission for 6 months were included in the study. At baseline, patients provided a single stool sample for calprotectin and lactoferrin determination. Follow-up was 12 months in patients showing no relapse and until activity flare in relapsing patients. Twenty-six patients (16%) relapsed during follow-up. Calprotectin concentrations in patients who suffered a relapse were higher than in nonrelapsing patients. Relapse risk was higher in patients having high calprotectin concentrations (30% versus 7.8%) or positive lactoferrin (25% versus 10%). Fecal calprotectin (>150 μg/g) sensitivity and specificity to predict relapse were 69% and 69%, respectively. Corresponding values for lactoferrin were 62% and 65%, respectively. Better results were obtained when only colonic CD disease or only relapses during the first 3 months were considered (100% sensitivity). The investigators concluded that fecal calprotectin and lactoferrin determination may be useful in predicting impending clinical relapse-especially during the following 3 months-in both CD and UC patients. This study did not confirm the utility of such findings in improving care and outcome of patients.
Garcia-Sanchez et al. (2010) performed a prospective study of 135 patients diagnosed with IBD in clinical remission for at least 3 months. All patients were followed-up for one year. Sixty-six patients had Crohn's disease (CD) and 69 had ulcerative colitis (UC). Thirty-nine (30%) suffered from relapse. The fecal calprotectin concentration was higher among the patients with relapse than in those that remained in remission. Patients with CD and calprotectin greater than 200 μg/g relapsed 4 times more often than those with lower marker concentrations. In UC, calprotectin greater than 120 μg/g was associated with a 6-fold increase in the probability of disease activity outbreak. The predictive value was similar in UC and CD with colon involvement and inflammatory pattern. In this group, calprotectin greater than 120 μg/g predicted relapse risk with a sensitivity of 80% and a specificity of 60%. Relapse predictive capacity was lower in patients with ileal disease. Larger studies are needed to demonstrate that fecal calprotectin testing has sufficient diagnostic accuracy to provide clinically relevant information when compared to other currently available diagnostic tests to allow for clinical decision-making