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An introduction to Research | CLDF small grants research programme | Faecal calprotectin is a non-invasive marker of inflammation but not allograft rejection following i
Faecal calprotectin is a non-invasive marker of inflammation but not allograft rejection following i
Introduction: Faecal calprotectin (FC) level is a marker of inflammation in inflammatory bowel disease, and a preliminary study has suggested it may be raised in intestinal allograft rejection. Our aim was to evaluate the use of FC as a non-invasive marker of small bowel inflammation and allograft rejection post intestinal transplantation. Methods: FC was analysed by ELISA in 100 samples of stomal fluid from 18 children (8 male, median age 3.3years, range 1.0-16.1) who received intestinal transplantation in a single centre from October 2006 - May 2008. Samples were taken concurrently with stomal biopsy weekly post-transplantation, or when rejection was suspected clinically. Results: Using Spearman rank analysis FC significantly correlated with inflammation determined by histology (p=0.000). Where no inflammation present median FC was 20.48ug/g (range 0-577.5). Where inflammation present median FC was 70.41ug/g (range 0-577.2). Area under receiver operating characteristics (ROC) curve (AUC) was 0.71 (Figure). A cut-off value of 43.19ug/g gave sensitivity and specificity 70.2% and 72% respectively for predicting inflammation. There was no significant correlation between FC and rejection determined by histology (p=0.876). Where no rejection present, median FC was 51.8ug/g (range 0-577.19), where rejection present median FC was 49.5ug/g (range 0-216.39). AUC was 0.51. Conclusion: FC level has good correlation with, and may be a useful non-invasive test for small bowel inflammation post intestinal transplantation, however it does not correlate with, and is not a useful diagnostic test for allograft rejection. Histological inflammation compared to no inflammation Area under the ROC curve | | Area | 0.7187 | Std. Error | 0.05924 | 95% confidence interval | 0.6026 to 0.8349 | P value | 0.0007907 | Data | | Control | 43 | Patient | 37 | Missing Controls | 0 | Missing Patients | 1 | | |
Cutoff FC | Sensitivity% | 95% CI | Specificity% | 95% CI | Likelihood ratio | > 5.920 | 91.89 | 78.09% to 98.30% | 20.93 | 10.04% to 36.04% | 1.16 | > 12.06 | 91.89 | 78.09% to 98.30% | 23.26 | 11.76% to 38.63% | 1.20 | > 12.67 | 89.19 | 74.58% to 96.97% | 23.26 | 11.76% to 38.63% | 1.16 | > 13.16 | 83.78 | 67.99% to 93.81% | 23.26 | 11.76% to 38.63% | 1.09 | > 13.46 | 83.78 | 67.99% to 93.81% | 27.91 | 15.33% to 43.67% | 1.16 | > 13.75 | 83.78 | 67.99% to 93.81% | 30.23 | 17.18% to 46.13% | 1.20 | > 13.87 | 83.78 | 67.99% to 93.81% | 32.56 | 19.08% to 48.54% | 1.24 | > 14.34 | 83.78 | 67.99% to 93.81% | 34.88 | 21.01% to 50.93% | 1.29 | > 15.17 | 83.78 | 67.99% to 93.81% | 37.21 | 22.98% to 53.28% | 1.33 | > 15.78 | 83.78 | 67.99% to 93.81% | 39.53 | 24.98% to 55.59% | 1.39 | > 16.60 | 83.78 | 67.99% to 93.81% | 41.86 | 27.01% to 57.87% | 1.44 | > 17.65 | 81.08 | 64.84% to 92.04% | 41.86 | 27.01% to 57.87% | 1.39 | > 18.76 | 81.08 | 64.84% to 92.04% | 44.19 | 29.08% to 60.12% | 1.45 | > 19.45 | 78.38 | 61.79% to 90.17% | 44.19 | 29.08% to 60.12% | 1.40 | > 19.65 | 78.38 | 61.79% to 90.17% | 46.51 | 31.18% to 62.35% | 1.47 | > 20.14 | 78.38 | 61.79% to 90.17% | 48.84 | 33.31% to 64.54% | 1.53 | > 21.58 | 78.38 | 61.79% to 90.17% | 51.16 | 35.46% to 66.69% | 1.60 | > 23.71 | 75.68 | 58.80% to 88.23% | 51.16 | 35.46% to 66.69% | 1.55 | > 25.24 | 72.97 | 55.88% to 86.21% | 51.16 | 35.46% to 66.69% | 1.49 | > 27.86 | 72.97 | 55.88% to 86.21% | 53.49 | 37.65% to 68.82% | 1.57 | > 30.06 | 72.97 | 55.88% to 86.21% | 55.81 | 39.88% to 70.92% | 1.65 | > 31.02 | 72.97 | 55.88% to 86.21% | 58.14 | 42.13% to 72.99% | 1.74 | > 32.16 | 72.97 | 55.88% to 86.21% | 60.47 | 44.41% to 75.02% | 1.85 | > 33.92 | 70.27 | 53.02% to 84.13% | 60.47 | 44.41% to 75.02% | 1.78 | > 37.38 | 70.27 | 53.02% to 84.13% | 62.79 | 46.72% to 77.02% | 1.89 | > 39.69 | 70.27 | 53.02% to 84.13% | 65.12 | 49.07% to 78.99% | 2.01 | > 41.01 | 70.27 | 53.02% to 84.13% | 67.44 | 51.46% to 80.92% | 2.16 | > 42.41 | 70.27 | 53.02% to 84.13% | 69.77 | 53.87% to 82.82% | 2.32 | > 43.19 | 70.27 | 53.02% to 84.13% | 72.09 | 56.33% to 84.67% | 2.52 | > 43.63 | 70.27 | 53.02% to 84.13% | 74.42 | 58.83% to 86.48% | 2.75 | > 44.05 | 70.27 | 53.02% to 84.13% | 76.74 | 61.37% to 88.24% | 3.02 | > 47.84 | 67.57 | 50.21% to 81.99% | 76.74 | 61.37% to 88.24% | 2.91 | > 51.87 | 64.86 | 47.46% to 79.79% | 76.74 | 61.37% to 88.24% | 2.79 | > 52.86 | 62.16 | 44.76% to 77.54% | 76.74 | 61.37% to 88.24% | 2.67 | > 53.98 | 62.16 | 44.76% to 77.54% | 79.07 | 63.96% to 89.96% | 2.97 | > 54.75 | 62.16 | 44.76% to 77.54% | 81.40 | 66.60% to 91.61% | 3.34 | > 56.46 | 59.46 | 42.10% to 75.25% | 81.40 | 66.60% to 91.61% | 3.20 | > 58.21 | 56.76 | 39.49% to 72.90% | 81.40 | 66.60% to 91.61% | 3.05 | > 60.54 | 56.76 | 39.49% to 72.90% | 83.72 | 69.30% to 93.19% | 3.49 | > 67.52 | 56.76 | 39.49% to 72.90% | 86.05 | 72.07% to 94.70% | 4.07 | > 72.73 | 54.05 | 36.92% to 70.51% | 86.05 | 72.07% to 94.70% | 3.87 | > 73.81 | 51.35 | 34.40% to 68.08% | 86.05 | 72.07% to 94.70% | 3.68 | > 74.90 | 48.65 | 31.92% to 65.60% | 86.05 | 72.07% to 94.70% | 3.49 | > 77.12 | 45.95 | 29.49% to 63.08% | 86.05 | 72.07% to 94.70% | 3.29 | > 79.18 | 40.54 | 24.75% to 57.90% | 86.05 | 72.07% to 94.70% | 2.91 | > 82.25 | 37.84 | 22.46% to 55.24% | 86.05 | 72.07% to 94.70% | 2.71 | > 85.12 | 35.14 | 20.21% to 52.54% | 86.05 | 72.07% to 94.70% | 2.52 | > 90.10 | 32.43 | 18.01% to 49.79% | 86.05 | 72.07% to 94.70% | 2.32 | > 103.4 | 29.73 | 15.87% to 46.98% | 86.05 | 72.07% to 94.70% | 2.13 | > 113.3 | 29.73 | 15.87% to 46.98% | 88.37 | 74.92% to 96.11% | 2.56 | > 116.1 | 29.73 | 15.87% to 46.98% | 90.70 | 77.86% to 97.41% | 3.20 | > 120.4 | 27.03 | 13.79% to 44.12% | 90.70 | 77.86% to 97.41% | 2.91 | > 130.6 | 24.32 | 11.77% to 41.20% | 90.70 | 77.86% to 97.41% | 2.61 | > 142.8 | 24.32 | 11.77% to 41.20% | 93.02 | 80.94% to 98.54% | 3.49 | > 151.4 | 21.62 | 9.827% to 38.21% | 93.02 | 80.94% to 98.54% | 3.10 | > 160.6 | 21.62 | 9.827% to 38.21% | 95.35 | 84.19% to 99.43% | 4.65 | > 167.0 | 21.62 | 9.827% to 38.21% | 97.67 | 87.71% to 99.94% | 9.30 | > 169.9 | 18.92 | 7.962% to 35.16% | 97.67 | 87.71% to 99.94% | 8.14 | > 183.3 | 16.22 | 6.193% to 32.01% | 97.67 | 87.71% to 99.94% | 6.97 | > 205.4 | 13.51 | 4.537% to 28.77% | 97.67 | 87.71% to 99.94% | 5.81 | > 229.9 | 10.81 | 3.025% to 25.42% | 97.67 | 87.71% to 99.94% | 4.65 | > 249.2 | 8.108 | 1.704% to 21.91% | 97.67 | 87.71% to 99.94% | 3.49 | > 255.0 | 5.405 | 0.6615% to 18.19% | 97.67 | 87.71% to 99.94% | 2.32 | > 416.1 | 2.703 | 0.06840% to 14.16% | 97.67 | 87.71% to 99.94% | 1.16 | > 577.4 | 0.0 | 0.0% to 9.489% | 97.67 | 87.71% to 99.94% | 0.00 | | | | | | |
| No inflammation | Inflammation | Number of values | 43 | 37 | Minimum | 0.0000 | 0.0000 | 25% Percentile | 13.26 | 23.71 | Median | 20.48 | 74.41 | 75% Percentile | 43.71 | 135.7 | Maximum | 577.5 | 577.2 | | | | Mean | 48.85 | 99.55 | Std. Deviation | 92.45 | 109.3 | Std. Error | 14.10 | 17.97 | | | | Lower 95% CI | 20.40 | 63.11 | Upper 95% CI | 77.30 | 136.0 |
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