EVALUATION OF THE ROLE OF FECAL CALPROTECTIN AS A BIOMARKER OF ENDOSCOPIC DISEASE ACTIVITY IN PATIENTS WITH CROHN’S DISEASE

Abstract

Introduction: Crohn's disease is a chronic inflammatory bowel illness with transmural inflammation and diverse clinical manifestations. Accurate assessment of disease activity is required to guide treatment and improve patient outcomes. This study assessed the diagnostic efficacy of fecal calprotectin as a biomarker of endoscopic disease activity in patients with Crohn's disease undergoing biologic therapy.
Methods: We conducted this prospective cohort study of 70 patients at Baghdad Teaching Hospital/Medical City between January 2024 and January 2025. We measured disease activity using the Simple Endoscopic Score for Crohn's Disease (SES-CD). We classified endoscopic activity as remission (0-2), mild activity (3-6), moderate activity (7-15), or severe activity (?16). Results: Among the 70 patients, 51 (72.8%) were in remission, while 19 (27.2%) had active disease after treatment. Active patients had significantly higher post-treatment fecal calprotectin levels than those in remission (367.89 vs. 111.83 ?g/g, P < .001). ROC analysis showed an area under the curve of 0.835 (P < .001). A fecal calprotectin cutoff of ?148.5 ?g/g resulted in 89.4% sensitivity, 70.6% specificity, 53.1% positive predictive value, and 94.7% negative predictive value. Conclusion: Fecal calprotectin effectively detects endoscopic disease activity in patients with Crohn's disease. Its high sensitivity and negative predictive value suggest it could be useful as a noninvasive monitoring tool, but the results should be interpreted in the context of this single-center investigation.