Guidance on the interpretation of faecal calprotectin levels in children
Heuschkel, Robert B.
Public Library of Science
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Orfei, M., Gasparetto, M., Hensel, K. O., Zellweger, F., Heuschkel, R. B., & Zilbauer, M. (2021). Guidance on the interpretation of faecal calprotectin levels in children. PLOS ONE, 16 (2) https://doi.org/10.1371/journal.pone.0246091
Background: Faecal calprotectin (FCP) is a powerful tool to predict inflammatory bowel disease (IBD) in patients with gastrointestinal symptoms. In the paediatric patient population, the reference value of < 50 μg/g and the influence of age on FCP levels result in a high number of redundant investigations and specialist referrals. We assessed paediatric FCP levels, their diagnostic value and corresponding referral pathways from primary and secondary care. Methods: We analysed two cohorts from a precisely defined catchment area: one consisted of all FCPs measured in this area (n = 2788). The second cohort—a subset of the first cohort—consisted of FCP values and corresponding clinical data from children who were referred for possible IBD to our department (n = 373). Results: In the first cohort, 47% of FCP levels were > 50 μg/g, 15% were ≥ 250 μg/g. Children < 1y had significantly (p < 0.001) higher FCP than older children. In the second cohort, 6.7% of children with an FCP of < 250 μg/g (or 8.6% with an FCP of < 600 μg/g) had IBD–all featured symptoms suggestive of IBD (e.g. bloody diarrhoea, nocturnal abdominal pain, weight loss) or abnormal blood tests. 76% of patients in whom raised FCP (> 50 μg/g) was the sole reason for being referred for suspected IBD did not have IBD. Conclusion: Children with an FCP < 600 μg/g and without matching symptoms suggestive of IBD are unlikely to have IBD. A higher FCP reference value may provide cost-effective improvement that could avoid redundant investigations and specialist referrals. A guideline for specialist referrals is proposed.
Research Article, Medicine and health sciences, People and places, Biology and life sciences
Gottfried und Julia Bangerter-Rhyner-Stiftung (ID 0102/2018)
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (172198)
Isaac Newton Trust (193645)
External DOI: https://doi.org/10.1371/journal.pone.0246091
This record's URL: https://www.repository.cam.ac.uk/handle/1810/317535
Attribution 4.0 International (CC BY 4.0)
Licence URL: https://creativecommons.org/licenses/by/4.0/