What is the Calprotectin Threshold for Disease Progression in Crohn’s Disease?

A recent retrospective study (NA Kennedy et al. Clin Gastroenterol Hepatol 2019; 17: 2269-76) with 918 patients with Crohn’s disease (CD) examined calprotectin levels and disease progression. Median followup was 50.6 months.

Key findings:

  • A calprotectin level cut-off of 115 mcg/g was identified as optimal for separation of those with and without disease disease progression.
  • The authors noted: “Several studies have identified a cut-off value of 250 mcg/g as being useful to distinguish active from inactive disease.  In the present study,…a lower threshold of 115 mcg/g (was identified) suggesting that lower levels of inflammatory activity still may be associated with an adverse outcome.”
  • The authors’ figure 2, as estimated by the empiric transition matrix method, shows disease progression over 30 years.  At that point,  the groups were nearly equally divide between stricturing disease, penetrating disease and inflammatory disease; in contrast at disease onset, ~80% had inflammatory disease behavior.

My take: As more effective therapies have become available, our goals for disease control have changed and focus on altering the disease course with more stringent endpoints.  For calprotectin, the lower number (115 compared to 250) indicates a much lower risk for disease progression.

Related blog posts:

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