Fecal Calprotectin For Detection Of Mucosal Healing In Inflammatory Bowel Disease Patients:A Meta-Analysis

Objective:The purpose of the study was to systematically review the diagnostic value of fecal calprotectin(FC)for assessing mucosal healing in inflammatory bowel disease(IBD),and explore the factors affecting the diagnostic accuracy.Methods:We systematically searched the databases: Pubmed,Cochrane Library,and Embase since inception to May 1,2018.Selected the articles that assessed the mucosal healing of IBD with FC based on the inclusion and exclusion criteria,and then extracted data from each study.Quadas-2 was used to assess the quality of the studies.The pool sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,summary receiver operating characteristics curve and area under the curve were performed by Meta-Disc 1.4.Results:27 studies(n=2651 patients)met the eligible criteria.The results showed that:(1)The pooled sensitivity and specificity of FC in assessing IBD mucosal healing were 0.79(95%CI: 0.77-0.82)and 0.79(95% CI: 0.77-0.81),respectively.In ulcerative colitis(UC)group,the pooled sensitivity and specificity were 0.78(95%CI: 0.74-0.81)and 0.82(95%CI: 0.79-0.84),respectivily.In Crohn’s disease(CD)group,the sensitivity and specificity of FC in predicting CD mucosal healing were 0.80(95%CI: 0.76-0.84)and 0.76(95%CI: 0.72-0.79).(2)Analysis by mucosal healing criteria showed that the specificity of FC in predicting partial mucosal healing was higher than complete mucosal healing,with specificity of 0.82(95%CI: 0.79-0.84)and 0.72(95%CI: 0.69-0.75).(3)The threshold of 50μg/g showed higher specificity(0.90,95%CI: 0.87-0.92),and the cut-off value of 250μg/g showed higher sensitivity(0.80,95%CI: 0.73-0.86)in detecting UC mucosal healing.In CD group,the specificity was higher at the value of 100μg/g(0.82,95%CI: 0.76-0.87),and the sensitivity was higher at the value of 200μg/g(0.82,95%CI: 0.75-0.87).(4)FC detected by Phical test showed better sensitivity and specificity for predicting IBD mucosal healing,with the sensitivity of 0.86(95%CI: 0.81-0.90)and 0.84(95%CI: 0.81-0.86),respectively.(5)Analysis according to CD disease location,found that the specificity of FC in predicting mucosal healing of colon involed CD(L2 or L3)was higher than terminal ileal CD(L1),with the specificity of 0.87(95%CI: 0.78-0.93)and 0.63(95%CI: 0.47-0.77),respectively.Conclusions:(1)FC was a reliable non-invasive indicator for predicting the mocasal healing of IBD,and could be used as an alternative to evaluate the mucosal healing of IBD patients.(2)The specificity of FC in predicting partial mucosal healing was higher than complete mucosal healing.(3)FC detected by Phical test showed better sensitivity and specificity for predicting IBD mucosal healing.(4)Compared with terminal ileal CD,FC maybe had better specificity in judging colon involved CD mucosal healing.