Faecal Calprotectin Predicts Endoscopic and Histological Activity in Clinically Quiescent Ulcerative Colitis

J Crohns Colitis. 2020 Jan 1;14(1):46-52. doi: 10.1093/ecco-jcc/jjz107.


Introduction: Faecal calprotectin [FC] is a reliable surrogate marker for disease activity in ulcerative colitis [UC]; however, there are no consensus cut-off values for remission. The study aim was to correlate FC with Mayo Endoscopic Score [MES] and histological disease activity of UC patients in clinical remission.

Methods: Our study recruited adult UC patients at the McGill IBD Center between 2013 and 2017. Patients in clinical remission [partial Mayo score ≤2], undergoing endoscopy for disease activity or dysplasia surveillance, were enrolled. Before bowel preparation, FC was collected. MES was documented during colonoscopy. Biopsies were taken; histological activity was assessed using Geboes score and the presence of basal plasmacytosis.

Results: A total of 185 patients were recruited. The area under the curve [AUC] in receiver operating characteristic [ROC] analysis to predict MES 1-3 [from 0] was 0.743 [95% CI 0.67-0.82; p <0.001] with an FC cut-off value 170 µg/g [64% sensitivity, 74% specificity], and to predict MES 2-3 [from 0-1] was 0.722 [95% CI 0.61-0.83; p <0.001] with an FC cut-off value 170 µg/g [69% sensitivity, 65% specificity]. To differentiate MES 0 from MES 1, an FC value 130 µg/g yields a 70% sensitivity and 68% specificity. The AUC in ROC analysis to predict Geboes <3.1 was 0.627 [95% CI 0.55-0.71; p = 0.003], with an FC value 135 µg/g [54% sensitivity, 69% specificity].

Conclusions: In this large study, FC ≥170 µg/g predicts endoscopic activity and FC ≥135 µg/g predicts histological activity. Therefore in clinical practice, lower faecal calprotectin thresholds can be chosen to optimise identification of patients with ongoing endoscopic and histological disease activity.

Keywords: Faecal calprotectin; endoscopic healing; histological remission; ulcerative colitis.

MeSH terms

  • Adult
  • Biomarkers / metabolism
  • Colitis, Ulcerative / metabolism*
  • Colitis, Ulcerative / pathology*
  • Colonoscopy*
  • Cross-Sectional Studies
  • Feces / chemistry*
  • Female
  • Humans
  • Leukocyte L1 Antigen Complex / metabolism*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • ROC Curve
  • Severity of Illness Index


  • Biomarkers
  • Leukocyte L1 Antigen Complex