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Profile of Consecutive Fecal Calprotectin Levels in the Perioperative Period and Its Predictive Capacity for Early Endoscopic Recurrence in Crohn’s Disease

Liu, Ruiqing, M.D.; Guo, Zhen, M.D., Ph.D.; Cao, Lei, M.D.; Wang, Zhiming, M.D., Ph.D.; Gong, Jianfeng, M.D., Ph.D.; Li, Yi, M.D., Ph.D.; Zhu, Weiming, M.D., Ph.D.

Diseases of the Colon & Rectum: March 2019 - Volume 62 - Issue 3 - p 318–326
doi: 10.1097/DCR.0000000000001263
Original Contributions: Inflammatory Bowel Disease
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BACKGROUND: The perioperative behavior of fecal calprotectin and whether it predicts early postoperative endoscopic recurrence of Crohn’s disease are unknown.

OBJECTIVE: We aimed to compare the perioperative profiles of fecal calprotectin between patients with Crohn’s disease and patients without Crohn’s disease undergoing intestinal resection and to identify the association between consecutive fecal calprotectin levels and endoscopic recurrence 3 months after surgery in patients with Crohn’s disease.

DESIGN: This was a prospective observational study.

SETTINGS: This study was conducted in a tertiary referral hospital.

PATIENTS: One hundred fourteen consecutive patients (90 Crohn’s disease, 24 non-Crohn’s disease) who underwent resection were recruited.

MAIN OUTCOME MEASURES: Univariate and multivariate analyses were performed to identify variations and risk factors. The predictive accuracy of the possible predictors was assessed by using receiver operating characteristic curves.

RESULTS: The fecal calprotectin levels on preoperative day 14 and postoperative days 14, 21, 28, 60, and 90 were higher in the Crohn’s disease group than they were in non-Crohn’s disease group (p < 0.05). Twenty patients (22.2%) developed endoscopic recurrence 3 months after resection. The trend for fecal calprotectin change (Δfecal calprotectin) from preoperative day 14 to postoperative day 14 was opposite in the recurrence and nonrecurrence groups. Multivariate analysis showed that this change was a predictive factor of early endoscopic recurrence (p < 0.05). ΔFecal calprotectin was more accurate at predicting early endoscopic recurrence than was fecal calprotectin at single time points with a cutoff value of 240 μg/g.

LIMITATIONS: This is a single-center trial with a limited cohort of patients.

CONCLUSIONS: The perioperative fecal calprotectin levels were higher in patients with Crohn’s disease than they were in the control group. The change in fecal calprotectin levels from preoperative day 14 to postoperative day 14 could serve as a practical predictive index for early postoperative endoscopic recurrence. See Video Abstract at

Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China

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Funding/Support: This study was supported by National Natural Science Foundation of China (81500429, 81570500) and Nanjing science and technology project (201715008).

Financial Disclosure: None reported.

Ruiqing Liu and Zhen Guo contributed equally to this article.

Correspondence: Weiming Zhu, M.D., Ph.D., Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Rd, Nanjing 210002, China. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons