A Meta-analysis Of The Effectiveness Of Feacal Calprotectin In Predicting Disease Relapse In UC And CD

Inflammatory bowel disease (IBD) is a chronic non-specific inflammation of intestinal tract, the cardinal symptom of which are diarrhoea, abdominal pain, tenesmus, et al[1]. The etiology of IBD has not been well understood and thus there has been no specific treatment for it, especially no effective forecast measures for the relapse, which are incidental to IBD patients. It is necessary to develop efficient precautions for the particular relapse of IBD, while the disease has brought too much pain on patients and the families. And current studies have focused on feacal calprotectin because of the special function in predicting disease relapse of IBD.Feacal calprotectin is a non-invasive measurement indicators responsing to inflammation of intestinal tract, which has been found in many studies to be capable of predicting relapse of IBD, and it was found in some studies to be better in predicting relapse of UC than CD. But each study had its own sensitivity and specificity, so it is necessary to collect all the data to draw a conclusion regarding the efficiency of feacal calprotectin in predicting disease relapse of IBD[2-5].Objective: To evaluate the efficiency of feacal calprotectin in predicting disease relapse in UC and CD through a meta-analysis.Methods: Through a MEDLINE and CNKI literature, searched articles (with the deadline of March, 2010) with feacal calprotectin in predicting relapse in IBD, Ulcerative colitis (UC) or Crohn's disease (CD), and collected the data that allowed calculation of the true-positive (TP), true-negative (TN), false-positive (FP) and false-negative (FN). Using the data evaluate weighted sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver-operating characteristic curve (SROC) of FC in patient populations with UC, CD and IBD as a whole.Result: Finally 5 articles reached the important exclusion/inclusion criteria. Data on the accuracy of different imaging modalities were analyzed and compared by constructing summary receiver-operating characteristic (SROC) curves. The pooled sensitivity,specificity,95% confidence interval and the area under the curve for UC relapse were 0.75 (0.62~0.85), 0.84 (0.78~0.90) and 0.92; 0.75 (0.66~0.83), 0.76 (0.71~0.81) and 0.81 for CD. Summary receiver operating characteristic analysis demonstrated better discriminatory power, and the most left side curve was found in UC, which was of the best effectiveness, and then was CD.Conclusion: According to the present findings, as a non-invasive measurement, the effectiveness of feacal calprotectin was moderate in predicting disease relapse in UC and CD, and there were no statistic differeces between their effectivenesses by Z test. It may be caused mainly by the different cutoffs, different standers (different indexs for diseases relapse, e.g. Crohn's Disease Activitity Index) and so on. Therefore, it is needed to carry out further studies, and researches on evidence-based medicine should be done and then the deep role of feacal calproctin in predicting IBD relapse will be acknowledged.