The Diagnostic Efficacy Of Fecal Calprotectin In Predicting Relapse Of Inflammatory Bowel Disease:a Meta-analysis

OBJECTIVE: inflammatory bowel disease(IBD)is a group of chronic non-specific inflammatory bowel disease,including ulcerative colitis(UC)and Crohn's disease(CD),which in the course of relapse and remission alternating characterized.Patients in clinical remission with inflammatory bowel disease may still exist histological inflammation in the intestinal wall,gradually increasing inflammation lead to relapse.Fecal calprotectin(FC)is associated with intestinal inflammation.Patients with clinical remission may have elevated FC,so the rise of FC may predict the recurrence of inflammatory bowel disease.This study was to investigate the diagnostic value of fecal calprotectin for the relapse of inflammatory bowel disease by the Meta-Analysis.METHODS: We searched the databases including PUBMED,EMBASE and Cochrane Library to collect the literature about fecal calprotectin test used to predict the recurrence of IBD from the database to August 2017.Meta-analysis was performed on Meta-disc 1.4 and StataSE12.0 software to assess the predictive value of fecal calprotectin for the recurrence of inflammatory bowel disease.RESULTS: Through literature search,a total of 13 studies were included in the meta-analysis.The total sample size was 1231 cases,of which 745 cases were UC and 486 cases were CD.Statistical analysis was performed on the value of FC in predicting the relapse of IBD disease.At the same time,subgroup analysis was performed on UC and CD respectively.The results showed that in the IBD group,the sensitivity,specificity,diagnostic odds ratio(DOR)and 95% confidence interval(CI),the area under curve(AUC)was 0.79(95% CI: 0.75-0.83),0.77(95% CI:0.74-0.80),13.44(95% CI: 7.68-23.53)and 0.86,respectively.The UC group was 0.77(95% CI: 0.71-0.82),0.78(95% CI: 0.73-0.79),11.13(95%CI: 6.01-20.62)and 0.84,respectively.The CD group was 0.75(95% CI:0.65-0.84),0.73(95% CI: 0.69-0.78),7.98(95% CI: 3.51-18.14)and 0.81,respectively.Thus,the AUC values of FC in IBD group,UC group and CD group were all above 0.80,indicating that FC has a good diagnostic value in the prediction of IBD disease relapse.From the results of the meta-analysis,the sensitivity and specificity of FC in predicting relapse of UC group were slightly higher than those in CD group,and the diagnostic odds ratio and area under the curve of SROC were higher in UC group than in CD group.The sensitivity,specificity,and DOR of FC in the range of100ug/g-150ug/g for FC predicting IBD relapse were 0.79(95% CI:0.73-0.85),0.72(AUC).95% CI: 0.67-0.77),11.62(95% CI: 4.55-29.66),0.83;when the cut off of FC was between 150ug/g-200ug/g,the combined sensitivity,specificity,and DOR and AUC were 0.77(95%).%CI:0.69-0.84),0.74(95% CI: 0.7-0.78),9.25(95% CI: 5.65-15.16),0.82;when the cut off of FC?200ug/g,the combined sensitivity,specificity,and DOR,AUC were 0.80(95% CI: 0.73-0.86),0.85(95% CI: 0.81-0.89),19.97(95% CI: 8.0-49.81),0.90,respectively.CONCLUSION: as a noninvasive and convenient detection method,fecal calprotectin has good diagnostic efficacy in predicting relapse of inflammatory bowel disease and may be predict UC relapse better than CD.In addition,as the cut off of FC increases,the specificity increases;when the FC is higher than 200 ? g/g,it may have the best diagnostic efficacy in predicting relapse of IBD.