scholarly journals Trefoil Factor 3 is Highly Predictive of Complete Mucosal Healing Independently and in Combination with C-Reactive Protein in Patients with Ulcerative Colitis

2019 ◽  
Vol 28 ◽  
pp. 169-174 ◽  
Author(s):  
Radislav Nakov ◽  
Tsvetelina Velikova ◽  
Ventsislav Nakov ◽  
Vanya Gerova ◽  
Lyudmila Tankova
Keyword(s):  
Ulcerative Colitis ◽  
Area Under The Curve ◽  
Predictive Marker ◽  
Mucosal Healing ◽  
Clinical Activity ◽  
Trefoil Factor ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Trefoil Factor 3 ◽  
Significant Difference

Aim: In the current study we aimed to evaluate the role of trefoil factor 3 (TFF3) as a marker for complete mucosal healing (MH) in patients with ulcerative colitis (UC). Methods: We enrolled 116 consecutive UC patients. Trefoil factor 3 levels were measured by ELISA and were compared to the clinical activity, assessed by Lichtiger Index, fecal calprotectin (FCP) and C-reactive protein (CRP) levels. Colonoscopy was performed in all the patients and the findings were graded according to Mayo endoscopic score (EMS) and UC endoscopic index of severity (UCEIS). Results: Trefoil factor 3 levels were significantly correlated with Lichtiger Index (r=0.736, p<0.001), EMS (r=0.811, p<0.001), UCEIS (r=0.820, p<0.001), FCP (r=0.696, p<0.001) and CRP (r=0.405, p<0.001). The TFF3 cut-off level of 6.74 ng/ml indicated complete MH (EMS=0; UCEIS=0) with a sensitivity and specificity of 0.879 and 0.869, respectively (area under the curve, AUC 0.927; 95% confidence interval, 0.877–0.976). The DeLong’s test revealed no significant difference between the AUC of TFF3+CRP and the AUC of FCP (Z=1.717, p=0.086), AUC of TFF3+FCP (Z=1.908, p=0.056), and AUC of TFF3+CRP+FCPP (Z=1.915, p=0.056). However, the AUC of TFF3+CRP showed significant difference compared with the AUC of TFF3 (Z=2.210, p=0.027) and the AUC of CRP (Z=3.145, p=0.002) for predicting complete MH. Conclusions: Trefoil factor 3 levels correlated significantly with clinical activity, endoscopic indices, CRP and FCP in our patients. TFF3 is a highly predictive marker of complete MH independently and in combination with CRP in patients with UC.

scholarly journals The Timing of Endoscopic Evaluation of Anti-TNFα Therapy Patients with Ulcerative Colitis

2020 ◽  
Vol 05 (03) ◽  
pp. 1-1
Author(s):  
Hiroyuki Kashiwagi ◽  
◽  
Ayumi Ito ◽  
Harutaka Kambayashi ◽  
Shun Murasugi ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Blood Test ◽  
Mucosal Healing ◽  
Optimal Timing ◽  
Test Results ◽  
C Reactive Protein ◽  
Endoscopic Evaluation ◽  
Reactive Protein ◽  
Endoscopic Findings ◽  
Significant Difference

Anti-TNFα Therapy are used to induce remission and as maintenance therapy in refractory ulcerative colitis (UC) to achieve mucosal healing (MH). However, the time at which mucosal healing should be assessed is unclear. We retrospectively examined the optimal timing for colonoscopy and the criteria to determine the need for the continuation of treatment. We evaluated 44 UC patients that were treated with anti-TNFα Therapy and categorized them into the following groups according to the degree of MH within 12 months: MH and non-MH/NMH, early-MH (EMH, healing within three months), and slow MH/SMH (healing between 4-12 months). We compared the Mayo Endoscopic Subscore (MES) between the MH vs. NMH and SMH vs. NMH groups. The Lichtiger index and blood test results were investigated as predictive factors of MH. MH was defined as an MES of ≤ 1. The MES was significantly lower in the MH group at 3, 6, and 12 months, compared to the NMH group. Significant changes were observed in the platelet counts, the Lichtiger index, the levels of C-reactive protein (lower), and hemoglobin (higher) in the MH group at 3- and 6-months following treatment. However, the only significant difference between the SMH and NMH groups was in the endoscopic findings at 6- or 12-months post-treatment. Colonoscopy should be performed three months after treatment with anti-TNFα Therapy. The treatment should be continued in patients who do not achieve mucosal healing at 3-months, and colonoscopy should be repeated at 6- or 12-months to assess the outcomes.

scholarly journals Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 829
Author(s):  
Yana Kogan ◽  
Edmond Sabo ◽  
Majed Odeh
Keyword(s):  
Area Under The Curve ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
C Reactive Protein ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Significant Difference ◽  
Study Population ◽  
Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

scholarly journals Rapid fecal calprotectin testing predicts mucosal healing better than C-reactive protein and serum tumor necrosis factor α in patients with ulcerative colitis

2015 ◽  
Vol 53 (3) ◽  
pp. 253-260
Author(s):  
T. Voiosu ◽  
Andreea Benguş ◽  
P. Bălănescu ◽  
Roxana Dinu ◽  
A. Voiosu ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Factor Α ◽  
Necrosis Factor

AbstractBackground and Aims. Serum and fecal biomarkers have been used as noninvasive methods for assessing disease activity in ulcerative colitis. C-reactive protein, serum tumor necrosis factor-α and fecal calprotectin are among the most promising such biomarkers. However, their role in the management of ulcerative colitis patients remains to be clarified. We aimed to evaluate the accuracy of C-reactive protein, fecal calprotectin and tumor necrosis factor-α in detecting clinical and endoscopic activity and predicting disease outcome.Methods. A cohort of ulcerative colitis patients was prospectively evaluated for clinical and endoscopic disease activity using the Mayo score. Serum C-reactive protein and tumor necrosis factor-α levels were measured and a point-of-care method was used for determining Calprotectin levels.Results. Fifty-three patients with ulcerative colitis were followed for a median of 12 months. Fecal calprotectin and C-reactive protein levels were significantly higher in patients with clinically active disease at baseline, but only calprotectin levels correlated with endoscopic activity. Calprotectin values over 300 μg/g had 60% sensitivity and 90% specificity for detecting active endoscopic disease and 61% sensitivity and 89% specificity for predicting mucosal healing.Conclusion. Rapid calprotectin testing is a better predictor of mucosal healing than serum biomarkers and it could improve the management of ulcerative colitis patients by decreasing the need for invasive investigations.

scholarly journals Physician Global Assessments or Blood tests do not Predict Mucosal Disease Activity in Ulcerative Colitis

2014 ◽  
Vol 28 (6) ◽  
pp. 325-329 ◽  
Author(s):  
Mayur Brahmania ◽  
Charles N Bernstein
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Complete Blood Count ◽  
Mucosal Healing ◽  
Physician Global Assessment ◽  
C Reactive Protein ◽  
Predictive Values ◽  
Laboratory Parameters ◽  
Reactive Protein ◽  
Blood Tests

BACKGROUND: Mucosal healing has been proposed as the therapeutic end point in the treatment of patients with ulcerative colitis (UC).OBJECTIVE: To investigate the relationship between physician global assessment (PGA) and laboratory blood tests (complete blood count, ferritin, C-reactive protein, albumin) and endoscopic findings in UC to determine whether they could be adequate surrogates for endoscopy.METHODS: A retrospective chart review of patients known to have UC from July 2008 to November 2012 was performed at the Health Sciences Centre, Winnipeg, Manitoba. Patients included individuals with UC who underwent colonoscopy within one month of clinic assessment. Blood tests were standard at the time of colonoscopy. Patients presenting through the emergency department, those with colonoscopies performed outside the authors’ institution, or whose colonoscopies and clinical assessments were undertaken more than one month apart were excluded. The PGA was used to determine disease activity in patients before colonoscopy. The Ulcerative Colitis Endoscopic Index of Severity, a validated scoring system to rate endoscopic disease severity in ulcerative colitis, was adapted.RESULTS: A total of 154 patients (mean [± SD] age 44±15.7 years) with UC were identified including 82 (53%) men. Mean hemoglobin level was 139 g/L, mean platelet level was 296×109/L, mean ferritin level was 102 μg/L, mean C-reactive protein level was 10 mg/L and mean albumin level was 40 g/L. Using endoscopy as the ‘gold standard’ for assessing UC activity (moderate-severe), abnormalities in laboratory parameters and PGA were both highly specific but not sensitive for identifying individuals with at least moderately active endoscopic disease. The PGA had higher positive and negative predictive values than the laboratory parameters.CONCLUSION: Neither blood tests nor PGA could replace endoscopy for assessing mucosal healing. When patients experienced active symptoms and abnormal serum markers, they were highly likely to have abnormal endoscopy. However, inactive symptoms or normal laboratory values did not preclude having active endoscopic disease.

scholarly journals Leucine-rich alpha-2 glycoprotein as a marker of mucosal healing in inflammatory bowel disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eriko Yasutomi ◽  
Toshihiro Inokuchi ◽  
Sakiko Hiraoka ◽  
Kensuke Takei ◽  
Shoko Igawa ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Immunochemical Test ◽  
Fecal Markers ◽  
Inflammatory Bowel

AbstractLeucine-rich alpha-2 glycoprotein (LRG) may be a novel serum biomarker for patients with inflammatory bowel disease. The association of LRG with the endoscopic activity and predictability of mucosal healing (MH) was determined and compared with those of C-reactive protein (CRP) and fecal markers (fecal immunochemical test [FIT] and fecal calprotectin [Fcal]) in 166 ulcerative colitis (UC) and 56 Crohn’s disease (CD) patients. In UC, LRG was correlated with the endoscopic activity and could predict MH, but the performance was not superior to that of fecal markers (areas under the curve [AUCs] for predicting MH: LRG: 0.61, CRP: 0.59, FIT: 0.75, and Fcal: 0.72). In CD, the performance of LRG was equivalent to that of CRP and Fcal (AUCs for predicting MH: LRG: 0.82, CRP: 0.82, FIT: 0.70, and Fcal: 0.88). LRG was able to discriminate patients with MH from those with endoscopic activity among UC and CD patients with normal CRP levels. LRG was associated with endoscopic activity and could predict MH in both UC and CD patients. It may be particularly useful in CD.

scholarly journals Serum Human Trefoil Factor 3 is a Biomarker for Mucosal Healing in Ulcerative Colitis Patients with Minimal Disease Activity

2015 ◽  
Vol 9 (7) ◽  
pp. 575-579 ◽  
Author(s):  
Saurabh Srivastava ◽  
Saurabh Kedia ◽  
Sushil Kumar ◽  
Venigalla Pratap Mouli ◽  
Rajan Dhingra ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Mucosal Healing ◽  
Minimal Disease Activity ◽  
Trefoil Factor ◽  
Trefoil Factor 3 ◽  
Minimal Disease

scholarly journals The albumin to globulin ratio is associated with mucosal healing in Japanese patients with ulcerative colitis: A cross-sectional study

2021 ◽  
Author(s):  
Sen Yagi ◽  
Shinya Furukawa ◽  
Kana Shiraishi ◽  
Masakazu Hanayama ◽  
Kazuhiro Tange ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Age At Onset ◽  
Japanese Patients ◽  
Mucosal Healing ◽  
Confounding Factors ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Protein Group ◽  
Albumin To Globulin Ratio

Abstract Background Ulcerative colitis (UC) is a chronic inflammatory disease. Mucosal healing (MH) is inversely associated with clinical outcome. The albumin to globulin ratio (AGR) is known as chronic inflammation marker. While some evidence regarding an association between AGR and some chronic diseases has been reported, no evidence regarding association between AGR and UC exists. The aim of this study to evaluated the association between AGR and MH among Japanese patients with UC. Methods The study subjects consisted of 273 Japanese patients with UC. AGR was divided into quartiles on the basis of the distribution of all study subjects. One endoscopic specialist was responsible for evaluating MH, which was defined as a Mayo endoscopic subscore of 0 or 0–1. Age, sex, steroid use, body mass index, age at onset of UC, and anti-TNFα preparation were selected a priori as potential confounding factors. Results The mean age was 51.2 years, and the percentage of male patients was 59.0%. The percentage of MH was 26.4%. High AGR (1.483 < AGR ≤ 1.643) and very high AGR (> 1.643) was significantly positively associated with MH (OR 2.21 [95% CI: 1.12–4.47], p for trend = 0.001) after adjustment for confounding factors. No association between AGR and partial MH was found. The independent positive association between AGR and MH was found in only low C-reactive protein group. Conclusion Among Japanese patients with UC, AGR was significantly positively associated with MH, was significantly positively associated with MH especially in the low C-reactive protein group.

scholarly journals Endoscopic score vs blood cell indices for determining timing of immunomodulator withdrawal in quiescent ulcerative colitis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kazuhiro Takenaka ◽  
Keiichi Tominaga ◽  
Mimari Kanazawa ◽  
Koh Fukushi ◽  
Takanao Tanaka ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Blood Cell ◽  
Activity Index ◽  
Mucosal Healing ◽  
Clinical Activity ◽  
Monitoring Methods ◽  
Mean Cell Volume ◽  
Remission Maintenance ◽  
Significant Difference ◽  
Activity Index Score

AbstractWhile immunomodulators (IMs) are used as key drugs in remission maintenance treatment for ulcerative colitis (UC), there has been no evidence to date for determining monitoring methods and drug withdrawal. Therefore, we examined if a decrease in white blood cell count (WBC) and an elevation in mean cell volume (MCV) could be used as optimization indices and if mucosal healing (MH) could be a rationale for determining the time of IM withdrawal. Subjects were 89 UC patients who were using IMs and for whom clinical remission had been maintained. Those with a Rachmilewitz Clinical Activity Index score of 4 or lower and those with a Mayo endoscopic subscore (MES) of 0 or 1 were defined as MH. The remission maintenance rates of the following comparative groups were examined: an IM continuation group and an IM withdrawal group; an IM continuation group with a WBC of less than 3000 or a MCV of 100 or greater and an IM continuation group with a WBC of 3000 or greater and a MCV of 99 or lower; an IM continuation group of patients for whom MH had been achieved and an IM continuation group of patients for whom MH had not been achieved; and an IM withdrawal group with a MES of 0 and an IM withdrawal group with a MES of 1. A significantly higher remission maintenance rate was observed in the IM continuation group compared to the withdrawal group (p < 0.01). No significant difference was observed between the IM continuation group with a WBC of less than 3000 or a MCV of 100 or greater and the IM continuation group with a WBC of 3000 or greater and a MCV of 99 or lower (p = 0.08). Higher remission maintenance rates were observed in the IM continuation group of patients for whom MH had been achieved compared to the IM continuation group of patients for whom MH had not been achieved (p = 0.03). No significant difference was observed between the IM withdrawal group with MES 0 and the IM withdrawal group with MES 1. (p = 0.48). This retrospective study showed that remission maintenance could be firmly obtained by continuing IM administration in case of endoscopic MH; however, MH was not an indicator of IM withdrawal.

Effectiveness and Safety of Golimumab in Treating Outpatient Ulcerative Colitis: A Real-Life Prospective, Multicentre, Observational Study in Primary Inflammatory Bowel Diseases Centers

2017 ◽  
Vol 26 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Antonio Tursi ◽  
Leonardo Allegretta ◽  
Nello Buccianti ◽  
Nicola Della Valle ◽  
Walter Elisei ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Diseases ◽  
Real Life ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Background & Aims: Golimumab (GOL) has been recently approved in Italy for the treatment of ulcerative colitis (UC) unresponsive to standard treatments. Our aims were to assess the real-life efficacy and safety of GOL in managing UC outpatients in Italian primary Inflammatory Bowel Diseases (IBD) centres.Methods: Consecutive UC outpatients with at least 3-months follow-up were enrolled. Primary end-point was the induction and maintenance of remission in UC, defined as Mayo score ≤2, at 6-month follow-up.Results: Ninety-three patients were enrolled. At 6-month follow-up, remission was obtained in 34 (36.5%) patients. Shorter duration of disease was the only significant predictive factor of remission. Clinical response was achieved in 60 (64.5%) patients, while mucosal healing (MH) was obtained in 18 (19.3%) patients. Sixteen (47.0%) patients under remission were still under therapy with steroids. C-reactive protein and fecal calprotectin significantly dropped during the follow-up (p<0.001 for both proteins). Adverse events occurred in 4 (4.3%) patients and 3 of them stopped treatment. Colectomy was performed in only one patient (1.1%).Conclusions: Golimumab seems to be safe and effective in inducing and maintaining remission in real life UC outpatients.Abbreviations: ADA: Adalimumab; CRP: C-reactive Protein; GOL: Golimumab; FC: Fecal calprotectin; IBD: Inflammatory Bowel Diseases; IFX: Infliximab; IQR: Interquartile range; MH: Mucosal Healing; SC: Subcutaneously; TBC: Tuberculosis; TNFα: Tumor necrosis factor α; UC: Ulcerative Colitis.    

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