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Meta-analysis: Fecal Calprotectin for Assessment of Inflammatory Bowel Disease Activity

Lin, Jin-Feng MD; Chen, Jin-Min MD; Zuo, Jun-Hua MD; Yu, Allen BS; Xiao, Zhu-Jun MD; Deng, Fei-Hong MD; Nie, Biao MD, PhD; Jiang, Bo MD, PhD

doi: 10.1097/MIB.0000000000000057
Original Clinical Articles

Background: Fecal calprotectin (FC) is a promising biomarker for diagnosis of inflammatory bowel disease (IBD). However, the utility of FC for assessment of IBD activity has yet to be clearly demonstrated. The aim of our study was to evaluate the diagnostic accuracy of FC for differentiating between patients with active IBD and those in remission.

Methods: We systematically searched the databases Medline, Web of Science, Cochrane Library, and EMBASE for eligible studies from December 2013 or earlier that evaluated activity in ulcerative colitis (UC) and Crohn's disease (CD). A hierarchical summary receiver operating characteristic model was performed to calculate the area under the curve to evaluate the overall diagnostic accuracy. The sensitivities and specificities of each commonly applied cutoff value were pooled using a random effects model.

Results: We included 13 studies (744 patients with UC and 727 with CD) in the final analysis. The area under the curve values were 0.89 (95% confidence interval, 0.86–0.92), 0.93 (0.89–0.97), and 0.88 (0.83–0.93) in the IBD, UC, and CD groups, respectively. For the IBD group at a cutoff value of 50 μg/g, the pooled sensitivity was 0.92 (0.90–0.94) and specificity 0.60 (0.52–0.67). For a cutoff value at 100 μg/g, the pooled sensitivity was 0.84 (0.80–0.88) and specificity was 0.66 (0.59–0.73). For a cutoff value at 250 μg/g, the pooled sensitivity was 0.80 (0.76–0.84) and specificity was 0.82 (0.77–0.86).

Conclusions: The FC test is a reliable marker for assessing IBD disease activity and may have greater ability to evaluate disease activity in UC than CD.

Article first published online 30 June 2014.

Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Reprints: Biao Nie, MD, PhD and Bo Jiang, MD, PhD, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhoudadaobei 1838, Guangzhou, Guangdong 510515, China (e-mail:;

The authors have no conflicts of interest to disclose.

J.-F. Lin and J.-M. Chen contributed equally to this work.

B. Nie and B. Jiang were co-corresponding authors of the article. Supported by the NanFang Hospital Fund for Distinguished Young Scholars, Grant 2013JQ03.

Received March 13, 2014

Accepted March 24, 2014

© Crohn's & Colitis Foundation of America, Inc.
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