The utility of a faecal calprotectin (FC) cut off >200 ug/g in a regional paediatric population. (24th May 2012) - Casey, A
Abstract : Introduction: FC has previously been shown to be markedly raised in children and adults with IBD with its stability allowing the convenient collection of this non-invasive marker in both inpatient and outpatient settings. Aims: Firstly to evaluate all FC results performed in a regional paediatric hospital and analyse patient outcome, for the 6 years after the test became routinely available in our NHS health board on 01/01/05. Secondly, to evaluate our 'clinical feel' that a FC cut-off of 200 ug/g is warranted as a guide to the likelihood of chronic GI inflammation, especially IBD, at first presentation. Method: All FC sample results were collated from children seen in a regional paediatric hospital between 01/01/05 and 31/12/10 and were cross checked with all hospital and GI department records, giving patient outcome with a minimum of 10 months and a maximum of 82 months follow up. 2nd or subsequent FC results from the same patient and insufficient samples were excluded. We then specifically evaluated the cut off of 200 ug/g for ability to identify patients at risk of IBD. Results: 1010 FC samples were sent that met inclusion criteria. 205 were >200 ug/g, with 162 (79%) of these patients having GI endoscopy; 103 (50%) were diagnosed with IBD. None of the 102 patients with FC >200 ug/g not diagnosed with IBD have subsequently developed it. 805 patients had a FC <200 ug/g, of which 171 (21%) have had GI endoscopy. Only 4 (2%) of these patients having GI endoscopy were diagnosed with IBD, which equates to 0.5% of all patients with a FC<200 ug/g. 634 (79%) patients with a FC <200 did not require GI endoscopy and have not subsequently developed IBD. Conclusion: This is the first study looking at all FC results when routinely available in a regional paediatric hospital over a prolonged period. We have shown that only 0.5% of patients with a FC<200 ug/g but 50% of those >200 ug/g have been diagnosed with IBD, confirming the validity of a FC >200 ug/g cut off for IBD in our paediatric population.