Fecal Calprotectin Correlates More Closely With the Simple Endoscopic Score for Crohn's Disease (SES-CD) than CRP, Blood Leukocytes, and the CDAI

OBJECTIVES: Studies evaluating the correlation between the widely used Simple Endoscopic Score for Crohn's disease (SES-CD) and noninvasive markers are scarce. The aim of this study was to evaluate the correlation between the SES-CD and fecal calprotectin, C-reactive protein (CRP), blood leukocytes, and the Crohn's disease activity index (CDAI). METHODS: Crohn's disease patients undergoing complete ileocolonoscopy were prospectively enrolled and scored independently according to the SES-CD and the CDAI. SES-CD was defined as follows: inactive 0-3; mild 4-10; moderate 11-19; and high >= 20. RESULTS: Values in CD patients (n=140 ileocolonoscopies) compared with controls (n=43) are as follows: calprotectin, 334 +/- 322 vs. 18 +/- 5 mu g/g; CRP, 26 +/- 29 vs. 3 +/- 2 mg/l; and blood leukocytes, 9.1 +/- 3.4 vs. 5.4 +/- 1.9 g/l (all P < 0.001). The SES-CD correlated closest with calprotectin (Spearman's rank correlation coefficient r=0.75), followed by CRP (r=0.53), blood leukocytes (r=0.42), and the CDAI (r=0.38). Calprotectin was the only marker that could discriminate inactive endoscopic disease from mild activity (104 +/- 138 vs. 231 +/- 244 mu g/g, P<0.001), mild from moderate activity (231 +/- 244 vs. 395 +/- 256 mu g/g, P=0.008), and moderate from high activity (395 +/- 256 vs. 718 +/- 320 mu g/g, P<0.001). The overall accuracy for the detection of endoscopically active disease was 87% for calprotectin (cutoff 70 mu g/g), 66% for elevated CRP, 54% for blood leukocytosis, and 40% for the CDAI >= 150. CONCLUSIONS: Fecal calprotectin correlated closest with SES-CD, followed by CRP, blood leukocytes, and the CDAI. Furthermore, fecal calprotectin was the only marker that reliably discriminated inactive from mild, moderate, and highly active disease, which underlines its usefulness for activity monitoring. Am J Gastroenterol 2010; 105: 162-169; doi:10.1038/ajg.2009.545; published online 15 September 2009