Performance of Quantitative Fecal Hemoglobin Versus Fecal Calprotectin as Markers of Crohn's Disease Activity and Severity

Hany M. Elsadek; Ahmad M. Hassaneen

Volume : V, Issue : I, January - 2015

Performance of Quantitative Fecal Hemoglobin Versus Fecal Calprotectin as Markers of Crohn's Disease Activity and Severity

Hany M. Elsadek, Ahmad M. Hassaneen

Abstract :

Background: Crohns disease (CD) is characterized by recurring flares and remissions. Fecal biomarkers especially fecal calprotectin (f–Cal) have promising results as non invasive tools to assess disease activity and severity. However, these markers are often difficult to process and expensive. The aim of this study was to evaluate the performance of quantitative fecal hemoglobin (f–Hb) measurement in comparison to f–Cal measurement, in the assessment of CD activity and severity. Methods: This study was performed on 52 patients of previously diagnosed Crohn’s disease, undergoing colonoscopy, and 26 healthy control subjects. Stool samples were collected for measurements of f–Hb and f–Cal, and blood samples for measurements of C–reactive protein (CRP) and routine blood tests. Endoscopic disease activity and severity were assessed and scored according to the Simple Endoscopic Score for CD (SES–CD). Results: There were significant positive correlations between SES–CD and all tested markers; serum CRP, f–Cal and f–Hb (r=0.395, r=0.670 and r=0.663, respectively). Using the statistically determined cutoff levels of f–Cal and f–Hb (177 µg/g and 1.6 µg/g, respectively), the sensitivity, specificity and overall diagnostic accuracies of both f–Cal and f–Hb in determining disease activity were very close (87.5% vs 83.3, 85.7% vs 85.7%, and 86.5 vs 84.6%, respectively) and much higher than that of CRP. Likewise, the sensitivity, specificity and overall diagnostic accuracies of both f–Cal and f–Hb in determining disease severity were also close (83.3% vs 83.3, 75.0% vs 66.7%, and 79.2 vs 75.0%, respectively). Conclusion: F–Hb can be used as a reliable simple and inexpensive marker of CD activity and severity with a diagnostic accuracy similar to f–Cal.