Zanesljivost testov Calprest in Liaison za oceno endoskopske aktivnosti ulceroznega kolitisa

Ekart, Nina (author), Osredkar, Joško (mentor), Drobne, David (comentor)

Ulcerozni kolitis je kronična vnetna črevesna bolezen, ki prizadene debelo črevo, povzroča dolgotrajno vnetje in razjede na sluznici. Natančno spremljanje bolezni običajno vključuje invazivne preiskave, kot je kolonoskopija, ki so za bolnike neprijetne in drage. V nalogi smo primerjali dva neinvazivna diagnostična testa, CALPREST in LIAISON, za merjenje fekalnega kalprotektina pri bolnikih z ulceroznim kolitisom. Namen raziskave je bil ugotoviti zanesljivost obeh testov in preveriti, kako meritve korelirajo z endoskopskimi rezultati, ki so standard za oceno aktivnosti bolezni. Uporabili smo vzorce blata 40 bolnikov, starih med 20 in 80 let z različnimi stopnjami endoskopskega vnetja, ki jih razdelimo na endoskopsko remisijo (Mayo 0), blago vnetje (Mayo 1), zmerno vnetje (Mayo 2) in hudo vnetje (Mayo 3). Vrednosti fekalnega kalprotektina smo izmerili s testoma CALPREST in LIAISON. Pri testu LIAISON so vrednosti znašale od 5,00 µg/g do 800,00 µg/g s povprečjem 288,24 µg/g, pri testu CALPREST pa od 1,00 µg/g do 791,00 µg/g s povprečjem 242,26 µg/g. Vrednosti testov smo primerjali z neparametričnim Wilcoxonovim testom, ki je pokazal statistično značilno razliko med metodama (p = 0,039), in s Spearmanovim koeficientom, ki je pokazal močno pozitivno povezanost (p = 0,795, p < 0,001). Rezultate testov smo primerjali z endoskopskimi rezultati, kjer smo kot endoskopsko izboljšanje opredelili endoskopski vrednosti Mayo 0 in 1, kot aktivno vnetje pa endoskopski vrednosti Mayo 2 in 3. Chi-kvadrat test je pokazal statistično značilno povezavo med koncentracijo fekalnega kalprotektina in kategorijami Mayo endoskopskih vrednosti za obe metodi, LIAISON (p = 0,014) in CALPREST (p = 0,036). Fischerjev test pa je potrdil povezavo za obe metodi (p < 0,05). Cramerjev V-koeficient, ki znaša 0,359 za LIAISON in 0,306 za CALPREST, nakazuje na zmerno povezanost med koncentracijami fekalnega kalprotektina in endoskopsko aktivnostjo. S pomočjo ROC krivulj in Youdenovega indeksa smo določili mejne vrednosti fekalnega kalprotektina, ki ločujejo med endoskopsko remisijo in prisotnostjo vnetja (47,95 µg/g za LIAISON ter 65 µg/g za CALPREST) ter med endoskopskim izboljšanjem in aktivnim vnetjem (68,55 µg/g za LIAISON in 125 µg/g za CALPREST). Ugotovitve kažejo, da sta testa učinkovitejša pri ločevanju endoskopske remisije od aktivnega vnetja kot pri razlikovanju med različnimi stopnjami vnetja. Oba testa zanesljivo merita fekalni kalprotektin, a sta primerljiva in zanesljivejša pri nižjih vrednostih. Pri višjih koncentracijah kalprotektina je potrebna previdnost pri interpretaciji.

• Language: Slovenian
• Keywords: ulcerozni kolitis, fekalni kalprotektin, statistična analiza, ELISA, CLIA, endoskopija, endoskopski Mayo indeks
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2024
• PID: 20.500.12556/RUL-164926
• Publication date in RUL: 17.11.2024

Secondary language

• Language: English
• Title: Reliability of Calprest and Liaison tests in assessing endoscopic activity of ulcerative colitis

Abstract

Ulcerative colitis is a chronic inflammatory bowel disease affecting the colon, causing prolonged inflammation and mucosal ulceration. Monitoring the disease typically requires invasive procedures like colonoscopy, which can be uncomfortable and costly for patients. This study compared two non-invasive tests, CALPREST and LIAISON, for measuring fecal calprotectin in patients with ulcerative colitis, aiming to evaluate their reliability and correlation with endoscopic results. We used stool samples from 40 patients aged between 20 and 80 years, with varying degrees of endoscopic inflammation, categorized into endoscopic remission (Mayo 0), mild inflammation (Mayo 1), moderate inflammation (Mayo 2), and severe inflammation (Mayo 3). Fecal calprotectin levels were measured using the CALPREST and LIAISON tests. The LIAISON test yielded values ranging from 5.00 µg/g to 800.00 µg/g, with a mean of 288.24 µg/g, while the CALPREST test ranged from 1.00 µg/g to 791.00 µg/g, with a mean of 242.26 µg/g. We compared the test results using the non-parametric Wilcoxon test, which revealed a statistically significant difference between the two methods (p = 0.039). The Spearman correlation coefficient indicated a strong positive correlation (p = 0.795, p < 0.001). We compared the test results with endoscopic findings, defining endoscopic improvement as Mayo scores of 0 and 1 and active inflammation as Mayo scores of 2 and 3. The Chi-square test demonstrated a statistically significant association between fecal calprotectin concentration and Mayo endoscopic categories for both methods, LIAISON (p = 0.014) and CALPREST (p = 0.036). Fisher's exact test confirmed this association for both methods (p < 0.05). Cramer's V coefficient, which was 0.359 for LIAISON and 0.306 for CALPREST, indicated a moderate correlation between fecal calprotectin concentrations and endoscopic activity. Using ROC curves and Youden's index, we determined cutoff values for fecal calprotectin that distinguish between endoscopic remission and inflammation (47.95 µg/g for LIAISON and 65 µg/g for CALPREST) and between endoscopic improvement and active inflammation (68.55 µg/g for LIAISON and 125 µg/g for CALPREST). Our findings suggest that both tests are more effective at distinguishing between endoscopic remission and active inflammation than at differentiating between varying degrees of inflammation. Both tests reliably measure fecal calprotectin, but they are comparable and more reliable at lower values. Caution is advised in interpreting results at higher calprotectin concentrations.

• Keywords: ulcerative colitis, fecal calprotectin, statistical analysis, endoscopy, ELISA, CLIA, endoscopic Mayo index