What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clin
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ORIGINAL ARTICLE
What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clinical remission? Jongbeom Shin 1 & Sung Min Kong 1 & Gyeol Seong 1 & Young-Ho Kim 1 Accepted: 14 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Noninvasive markers for predicting endoscopic remission (ER) in patients with ulcerative colitis (UC) who are in clinical remission (CR) are important for the determination of appropriate treatment modality. C-reactive protein (CRP) is a surrogate marker for assessing disease activity, albeit with a low sensitivity and specificity when the cut-off value is 0.3 or 0.5 mg/ dL, which is usually considered normal. The CRP test has been improved, and even fine values within the normal range can be measured. The aim of this study was to determine the appropriate cut-off value of CRP below 0.3 mg/dL for the prediction of ER in UC patients with CR. Methods A total of 132 patients who underwent endoscopic evaluation during CR were retrospectively reviewed. Clinical and endoscopic activity was measured using a simple clinical colitis activity index (SCCAI) and Mayo endoscopic subscore (MES). ER was defined as MES 0 or 1. Results In UC patients in CR, the CRP level was significantly lower in ER (0.05, 0.03–2.57) vs. non-ER (0.14, 0.03–2.81) (p < 0.001). The CRP value predicted ER [area under the curve (AUC = 0.710)] with a sensitivity of 71.4% and a specificity of 71.7% at a cut-off value of 0.09 mg/dL. In contrast, the value of normal CRP (< 0.3 mg/dL) did not show sufficient predictive value (sensitivity, 27.3%; and specificity, 90.9%). Conclusions In UC patients in CR, it may be helpful to lower the CRP cut-off value that predict ER other than 0.3 mg/dL, which is usually considered normal. Keywords CRP . Ulcerative colitis . Clinical remission . Endoscopic remission
Introduction Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder with remission and relapsing phases [1–3]. The therapeutic goal of UC is to induce and maintain clinical remission (CR). Recently, it has been possible to attain endoscopic remission (ER) [4–6], a condition in which mucosal inflammation, ulceration, and friability are not identified endoscopically. ER is correlated with decreased rate of clinical relapse and Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03705-9) contains supplementary material, which is available to authorized users. * Young-Ho Kim [email protected] 1
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, Korea
minimal surgical intervention [7, 8]. Furthermore, reports suggest that histologic remission is associated with a better prognosis than ER [9]. However, persistent mucosal inflammation increases the risk of colectomy and colon cancer [10]. Notably, mucosal inflammation, which increases the risk of complications, may be uncontrolled in patien
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