■粪便钙卫蛋白(FC)是克罗恩病(CD)术后活动性肠道炎症的可靠预测因子,但是研究之间的截止时间有所不同。最近的指南建议截止值<50ug/g,以避免在CD复发的预测试概率较低的患者中进行常规内窥镜检查。我们在回肠结肠切除术(ICR)后的真实世界CD队列中评估了该阈值的性能。
■在这项回顾性研究中,我们从多中心数据库中纳入2009年至2020年间ICR后,FC>60天,但手术时间<1年的CD患者.确定的危险因素和/或生物预防(手术90天内的生物)定义的预测试概率。未进行术后结肠镜检查者除外。内镜下复发率,定义为手术后任何时间的Rutgeerts评分≥i2b,比较FC<50与≥50ug/g之间的差异。采用Studentt检验和Fisher精确检验进行统计分析。所有术后FCs在1年内与最接近的结肠镜检查相匹配,以计算灵敏度,特异性,阳性预测值(PPV),和阴性预测值(NPV)。
■37例患者被归类为低风险或高风险,接受了生物预防和术后结肠镜检查。第一次FC的中位时间为217天(IQR131-288)。15例(41%)患者初始FC<50ug/g,22例(59%)≥50ug/g。首次结肠镜检查的中位时间为234天(IQR189-369)。与初始FC≥50ug/g相比,FC<50ug/g经历了较少的内镜下复发(0%vs.36%,P=.005)。FC≥50ug/g患者首次内镜复发的中位时间为145天。有39对匹配的FC和结肠镜检查。在FC截止值为50ug/g时,计算灵敏度为90%,净现值为93%,而特异性和PPV分别为48%和38%,分别。
■在这个现实世界中,FC<50ug/g是在ICR后CD人群中排除内镜下复发的有用截止值,该人群的复发概率较低。
UNASSIGNED: Fecal calprotectin (FC) is a reliable predictor of active bowel inflammation in postoperative Crohn\'s disease (CD), but cutoffs vary between studies. Recent guidelines recommend a cutoff of <50 ug/g to avoid routine endoscopy in patients at low pretest probability for CD recurrence. We evaluated the performance of this threshold in a real-world CD cohort after ileocolic resection (ICR).
UNASSIGNED: In this retrospective study, patients with CD post-ICR between 2009 to 2020 with FC > 60 days but < 1 year of surgery were included from a multicenter database. Established risk factors and/or biologic prophylaxis (biologic within 90 days of surgery) defined pretest probability. Those without postoperative colonoscopy were excluded. Rates of endoscopic recurrence, defined as Rutgeerts score ≥ i2b at any time after surgery, were compared between FC < 50 versus ≥ 50 ug/g. Student\'s t-test and Fisher\'s exact test were utilized for statistical analysis. All postoperative FCs were matched to closest colonoscopy within 1 year to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
UNASSIGNED: Thirty-seven patients categorized as either low-risk or high-risk and received biologic prophylaxis and had postoperative colonoscopy were included. Median time to first FC was 217 days (IQR 131-288). 15 (41%) patients had initial FC < 50 ug/g versus 22 (59%) ≥50 ug/g. Median time to first colonoscopy was 234 days (IQR 189-369). Compared to initial FC ≥ 50 ug/g, FC < 50ug/g experienced less endoscopic recurrence (0% vs. 36%, P = .005). Median time to first endoscopic recurrence in FC ≥ 50 ug/g was 145 days. There were 39 matched pairs of FC and colonoscopy. At an FC cutoff of 50 ug/g, calculated sensitivity was 90% and NPV was 93%, whereas specificity and PPV were 48% and 38%, respectively.
UNASSIGNED: In this real-world cohort, FC < 50 ug/g is a useful cutoff to exclude endoscopic recurrence in a post-ICR CD population that is at low pretest probability of recurrence.