Magro F1,2,3, Lopes S1, Coelho R1, Cotter J4, Dias de Castro F4, Tavares de Sousa H5,6, Salgado M7, Andrade P1, Vieira AI8, Figueiredo P8, Caldeira P9, Sousa A9, Duarte MA10, Ávila F10, Silva J11, Moleiro J11, Mendes S12, Giestas S12, Ministro P13, Sousa P13, Gonçalves R14, Gonçalves B14, Oliveira A15, Chagas C16, Torres J17, Dias CC18,19, Lopes J20, Borralho P21, Afonso J2,3, Geboes K22, Carneiro F20,23; Portuguese IBD Study Group [GEDII].
1Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal.
2Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.
3MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal.
4Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.
5Department of Gastroenterology, Centro Hospitalar do Algarve - Portimão Unit, Portimão, Portugal.
6Departament of Medicine and Medical Biosciences, University of Algarve, Faro, Portugal.
7Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Portugal.
8Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal.
9Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal.
10Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal.
11Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal.
12Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
13Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
14Department of Gastroenterology, Hospital de Braga, Braga, Portugal.
15Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal.
16Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
17Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal.
18CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
19CINTESIS, Center for Health Technology and Services Research, Porto, Portugal.
20Department of Pathology, Centro Hospitalar São João, Porto, Portugal.
21Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
22Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium.
23Institute of Molecular Pathology and Immunology of the University of Porto [Ipatimup], University of Porto, Porto, Portugal.
ABSTRACT
Background and aims Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B–associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients. Methods This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers. Results Macroscopic lesions [i.e. endoscopic Mayo score ≥1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of Severity. Moreover, 21% presented with histological inflammation according to the Geboes index, whereas 15% and 5% presented with focal and diffuse basal plasmacytosis, respectively. The faecal levels of calprotectin and neutrophil gelatinase B–associated lipocalin were statistically higher for patients with endoscopic lesions and histological activity. A receiver operating characteristic–based analysis revealed that both biomarkers were able to indicate mucosal healing and histological remission with an acceptable probability, and cut-off levels of 150–250 μg/g for faecal calprotectin and 12 μg/g for neutrophil gelatinase B–associated lipocalin were proposed. Conclusions Faecal calprotectin and neutrophil gelatinase B–associated lipocalin levels are a valuable addition for assessment of disease activity in asymptomatic ulcerative colitis patients. Biological levels of the analysed biomarkers below the proposed thresholds can rule out the presence of macroscopic and microscopic lesions with a probability of 75–93%. However, caution should be applied whenever interpreting positive results, as these biomarkers present consistently low positive predictive values.
