Effect of disease duration on fecal biomarkers in ulcerative colitis: a prospective cohort study

Abstract

Background: Biomarkers such as fecal calprotectin (FC) and fecal immunochemical occult blood tests (FIT) for ulcerative colitis (UC) are used in clinical practice. In this study, the effect of UC disease duration on FC was investigated and compared to that on FIT.

Methods: One hundred twenty-eight colonoscopic examinations and two fecal biomarkers measurements were performed. The cases of UC were divided into short- and long-term disease-duration groups or categorized into three groups with disease durations of 0-5, 6-13, and 14-38 years. We analyzed correlations between biomarker levels and endoscopic scores, including the Mayo endoscopic subscore (MES), ulcerative colitis endoscopic index of severity, and the sum of MES.

Results: In the analysis of short- and long-term disease durations, the three endoscopic scores and biomarker levels showed significant correlations in both long-term and short-term groups. Most of the correlation coefficients for the individual long-term group were lower than the corresponding values for all cases, while most of the correlation coefficients for the individual short-term groups were higher than the corresponding values for all cases. In the three-group analysis (disease durations of 0-5, 6-13, and 14-38 years), the two biomarkers and three endoscopic scores showed significant correlations, and most of the correlation coefficients between biomarkers and endoscopic scores tended to be lower in the long-term follow-up group. In the receiver operating characteristic analysis for predicting mucosal healing in the three groups, the area under the curve for FC and FIT concentrations in the 0-5 year disease-duration group showed particularly higher values than those for the other two groups.

Conclusions: Similar to FIT, FC is affected by the duration of UC, indicating that FC may be a highly useful biomarker, especially in short-term disease.

Keywords: Biomarker; Disease duration; Fecal calprotectin; Fecal immunochemical occult blood test; Ulcerative colitis.

Fig. 1

Study flow diagram. Two cohorts were evaluated in the present study. In Cohort 1, patients with long- and short-term disease durations were extracted and analyzed according to disease duration. In Cohort 2, all cases were divided into three groups in the order of disease duration such that the number of cases in each group was almost the same, and analysis was performed in these three groups

Fig. 2

Bar graphs of the correlation coefficients between fecal biomarkers and Mayo endoscopic subscore (MES)/ ulcerative colitis endoscopic index of severity (UCEIS) scores categorized by disease duration. The dark-blue and orange bar graphs represent the fecal calprotectin (FC) and fecal immunochemical occult blood test (FIT) concentrations, respectively. The blue and red dashed lines indicate the correlation coefficients with FC and FIT concentrations in all cases, respectively. Bar graphs of the correlation coefficient between fecal biomarker concentrations and MES in the long-term (a) and short-term (b) disease-duration groups. Bar graphs of the correlation coefficients between fecal biomarker concentrations and UCEIS in long-term (c) and short-term (d) disease-duration groups

Fig. 3

Bar graphs of the correlation coefficient between fecal biomarkers and the sum of Mayo endoscopic subscore (MES) by disease duration. The dark-blue and orange bar graphs represent the fecal calprotectin (FC) and fecal immunochemical occult blood test (FIT) concentrations, respectively. The blue and red dashed lines indicate the correlation coefficients with the FC and FIT concentrations in all cases, respectively. Bar graphs of the correlation coefficients with fecal biomarkers and the sum of MES in the long-term (a) and short-term (b) disease-duration groups

Fig. 4

Receiver operating characteristic (ROC) curve analysis for predicting mucosal healing in the three groups according to disease duration. ROC curve of fecal calprotectin (FC) and fecal immunochemical occult blood test (FIT) in all cases (a). ROC curves of FC and FIT in the groups of disease duration 0–5 years (b), 6–12 years (c), and 13–38 years (d)