Comparison of the diagnostic capabilities of fecal and serum markers in determining the severity of an ulcerative colitis attack

Abstract

Background. The clinical manifestations of ulcerative colitis are heterogeneous and may change over time. The main problem at present is the search for non-invasive diagnostic markers to assess the activity and severity of an attack in patients with ulcerative colitis. Aim. Comparative evaluation of the diagnostic significance of serum and fecal biomarkers depending on the severity of an attack of ulcerative colitis. Material and methods. 178 patients with ulcerative colitis were divided into 4 groups depending on the presence and severity of the attack, the control group included 40 patients with irritable bowel syndrome. The cytokine profile (interleukins-1, -2, -4, -6, -10, -17, tumor necrosis factor ) and the concentration of fecal markers (lactoferrin, calprotectin, neopterin) were determined, the clinical activity index (CAI) and scores according to Mayo scale were assessed. Dispersion, correlation and ROC analysis were used. The indicators are presented as M (SD) for parametric distribution and as Me (2575) for non-parametric distribution. Differences were considered statistically significant at p 0.05. Results. Patients with ulcerative colitis showed a statistically significant correlation of Mayo scores with the CAI index (r=0.815, p=0.001), interleukin-6 (r=0.598, p=0.001), interleukin-17 (r=0.587, p=0.005 ), tumor necrosis factor (r=0.701, p=0.001), fecal calprotectin (r=0.881, p=0.001), lactoferrin (r=0.799, p=0.001), neopterin (r=0.791, p=0.001). Statistically significant correlations between CAI and interleukin-6 (r=0.525, p=0.001), interleukin-17 (r=0.587, p=0.005), tumor necrosis factor (r=0.624, p=0.001), fecal calprotectin (r=0.831, p=0.001), lactoferrin (r=0.672, p=0.005), neopterin (r=0.765, p=0.002) were found. Cut-off points for serum markers in predicting endoscopically active disease were as follows: interleukin-6 9.6 pg/ml, interleukin-17 6.6 pg/ml, tumor necrosis factor 7.6 pg/ml; cut-off points for fecal markers: calprotectin, 78.6 g/g; lactoferrin 765 g/g; neopterin 79.5 g/g. Conclusion. A higher diagnostic significance of the use of fecal biomarkers compared to serum biomarkers, as well as the advantages of fecal calprotectin in terms of sensitivity and specificity among all the indicators we studied were revealed.