İnflamatuvar Bağırsak Hastalarında Serum Prokalsitonin Değerleri Hastalık Aktivitesi ile İlişkilidir

Year 2025, Volume: 17 Issue: 1, 60 - 67, 27.03.2025

İrfan Küçük , Süleyman Baş

Abstract

Amaç: İnflamatuar barsak hastalıkları (İBH) olan vakalarda hastalık aktivitesi ile serum prokalsitonin (SPCT) değerleri arasındaki korelasyonlar ile ilgili veriler çelişkili olup tam olarak belirlenememiştir. Çalışmamızda ülseratif kolitli (ÜK) hastalarda mukozal inflamasyonun derecesine ilave olarak, İBH hastalık aktivitesinin değişik klinik ve laboratuvar fenotipleri ile SPCT düzeyleri değerlendirilmiş ve SPCT’nin yararlı bir biyobelirteç olup olamayacağı araştırılmıştır.
Yöntem: Bu retrospektif vaka-kontrol çalışmasına 132 ÜK hastası, 83 Crohn hastalığı (CH) vakası ve 72 sağlıklı kontrol (SK) dahil edilmiştir. ÜK klinik aktivitesi için Mayo klinik skorlama sistemi (MKS), histolojik aktivite indeksi (HAİ) için Truelove ve Richards yöntemleri kullanıldı. CH‘da klinik aktivite için Crohn hastalığı aktivite indeksi (CHAİ) kullanıldı. İBH’nın endoskopik lokalizasyonu Montreal sınıflandırmasına göre yapılmıştır.
Bulgular: Median SPCT düzeyleri ÜK ve CH hastalarında SK’'e göre daha yüksekti (0.07 vs 0.26 vs 0.03 ng/ml, sırasıyla, p<0.001). ÜK’de MKS ve CH’da CHAİ’e göre aktif hastalığı olanlarda remisyonda olanlara göre median SPCT değerleri daha yüksekti (p<0.001, p=0.033, sırasıyla). Fistülü ve/veya apsesi olan CH vakalarında olmayanlara göre daha yüksek median SPCT seviyeleri tespit edildi (p<0,001). ÜK hastalarında SPCT düzeyleri ile MKS ve HAİ değerleri arasında pozitif korelasyon saptandı (p<0.001 her ikisi için).
Sonuç: Hastalık aktivitesinin belirlenmesinde İBH’da SPCT değerleri uygun maliyetli ve pratik bir biyobelirteç olarak kullanılabilir.

Keywords

Hastalık aktivitesi, İnflamatuar bağırsak hastalığı, Prokalsitonin

Serum Procalcitonin Values Relate to Disease Activity in Patients with Inflammatory Bowel Diseases

Abstract

Objective: In inflammatory bowel disease (IBD) patients, the correlation between disease activity and serum procalcitonin (SPCT) values remains elusive. By using a number of clinical and laboratory phenotypes of disease activity in conjunction with the degree of mucosal inflammation in patients with ulcerative colitis (UC), we sought to determine whether the blood SPCT levels of IBD patients could be useful as a biomarker.
Methods: This retrospective case-control study was conducted with 132 UC patients, 83 Crohn’s disease (CD) patients, and 72 healthy controls (HCs). In UC, endoscopic and clinical activity were identified using the Mayo Clinical Scoring System (MCS), and the histological activity index (HAI) was calculated using the Truelove and Richards technique. The Crohn's disease activity index (CDAI) of CD patients was calculated. The Montreal classification was preferred for determining disease localization in IBD patients.
Results: The median SPCT levels were higher in the UC and CD patients compared to the HC (0.07 vs 0.26 vs 0.03 ng/ml, respectively, p<0.001). The MCS of UC and the CDAI of CD patients having active disease showed higher median SPCT levels than the patients in remission (p<0.001, p=0.033, respectively). The CD patients with a fistula and/or an abscess had higher SPCT concentrations than CD patients without a fistula and/or abscess (p<0.001). In the UC group, SPCT levels were positively correlated to the MCS and HAI values (p<0.001 for both values).
Conclusions: For the disease activity of IBDs, SPCT values may be a cost-effective and practical biomarker.

Keywords

Disease activity, Inflammatory bowel disease, Procalcitonin

Ethical Statement

All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version. Additionally, there are no conflicts of interest in connection with this paper, and the material described is not under publication or consideration for publication elsewhere. All human studies have been performed under the rules of 1964 Declaration of Helsinki.

References

• 1. Osterman MT, Lichtenstein GR. Ulcerative Colitis. In: Feldman M, Friedman SL. Brandt JL editors (Eds). Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Philadelphia (USA): Elselvier Saunders; 2016. p. 2023-61.
• 2. Kıraç Y, Yalçın B, Ustaoğlu M. The Relationship between Smoking Status, Carbon Monoxide Levels and Quality of Life, Disease Characteristics in Inflammatory Bowel Diseases. Konuralp Medical Journal. 2023;15(1):69-77.
• 3. Con D, Andrew B, Nicolaides S, van Langenberg DR, Vasudevan A. Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy. Intest Res. 2022;20(1):101-13.
• 4. Truelove SC, Wıtts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041-8.
• 5. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317(26):1625-9.
• 6. Best WR, Becktel JM, Singleton JW, Kern F Jr. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976;70(3):439-44.
• 7. Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. BMJ. 1989;298(6666):82-6.
• 8. Chen F, Hu Y, Fan YH, Lv B. Clinical Value of Fecal Calprotectin in Predicting Mucosal Healing in Patients With Ulcerative Colitis. Front Med (Lausanne). 2021;8:679264.
• 9. Ardizzone S, Cassinotti A, Duca P, Mazzali C, Penati C, Manes G, et al. Mucosal healing predicts late outcomes after the first course of corticosteroids for newly diagnosed ulcerative colitis. Clin Gastroenterol Hepatol. 2011;9(6):483-9.
• 10. Bryant RV, Winer S, Travis SP, Riddell RH. Systematic review: histological remission in inflammatory bowel disease. Is 'complete' remission the new treatment paradigm? An IOIBD initiative. J Crohns Colitis. 2014;8(12):1582-97.
• 11. Samsudin I, Vasikaran SD. Clinical Utility and Measurement of Procalcitonin. Clin Biochem Rev. 2017;38(2):59-68.
• 12. Lippi G, Sanchis-Gomar F. Procalcitonin in inflammatory bowel disease: Drawbacks and opportunities. World J Gastroenterol. 2017;23(47):8283-90.
• 13. Demir İ, Yılmaz İ. The Effect of Polypharmacy on Procalcitonin Levels in The Intensive Care Admission of Geriatric Patients with Sepsis. Konuralp Medical Journal. 2020;12(2):216-22.
• 14. Oruç N, Ozütemiz O, Osmanoğlu N, Ilter T. Diagnostic value of serum procalcitonin in determining the activity of inflammatory bowel disease. Turk J Gastroenterol. 2009;20(1):9-12.
• 15. Koido S, Ohkusa T, Takakura K, Odahara S, Tsukinaga S, Yukawa T, et al. Clinical significance of serum procalcitonin in patients with ulcerative colitis. World J Gastroenterol. 2013;19(45):8335-41.
• 16. Oussalah A, Laurent V, Bruot O, Guéant JL, Régent D, Bigard MA, et al. Additional benefit of procalcitonin to C-reactive protein to assess disease activity and severity in Crohn's disease. Aliment Pharmacol Ther. 2010;32(9):1135-44.
• 17. Ge X, Hu D, Cao Y, Liu Z, Ding C, Tian H, et al. Procalcitonin in Crohn's disease with fever episodes, a variable to differentiate intra-abdominal abscess from disease flares. Int J Surg. 2016;36(Pt A):34-9.
• 18. Wu HM, Wei J, Li J, Wang K, Ye L, Qi Y, et al. Serum Procalcitonin as a Potential Early Predictor of Short-Term Outcomes in Acute Severe Ulcerative Colitis. Dig Dis Sci. 2019;64(11):3263-73.
• 19. Chen JM, Liu T, Gao S, Tong XD, Deng FH, Nie B. Efficacy of noninvasive evaluations in monitoring inflammatory bowel disease activity: A prospective study in China. World J Gastroenterol. 2017;23(46):8235-47.
• 20. Nishio E, Saruta M, Arihiro S, Matsuoka M, Mitsunaga M, Ide D, et al. The clinical benefit of procalcitonin to assess disease activity and severity in inflammatory bowel disease. Gastroenterology. 2016;150(4, Supplement 1):995.
• 21. Hosomi S, Yamagami H, Itani S, Yukawa T, Otani K, Nagami Y, et al. Sepsis Markers Soluble IL-2 Receptor and Soluble CD14 Subtype as Potential Biomarkers for Complete Mucosal Healing in Patients With Inflammatory Bowel Disease. J Crohns Colitis. 2018;12(1):87-95.
• 22. Chung SH, Lee HW, Kim SW, Park SJ, Hong SP, Kim TI, et al. Usefulness of Measuring Serum Procalcitonin Levels in Patients with Inflammatory Bowel Disease. Gut Liver. 2016;10(4):574-80.
• 23. Truelove SC, Richards WCD. Biopsy studies in ulcerative colitis. Br Med J. 1956;1(4979):1315-8.
• 24. Brull DJ, Serrano N, Zito F, Jones L, Montgomery HE, Rumley A, et al. Human CRP gene polymorphism influences CRP levels: implications for the prediction and pathogenesis of coronary heart disease. Arterioscler Thromb Vasc Biol. 2003;23(11):2063-9.
• 25. Sakurai T, Saruta M. Positioning and Usefulness of Biomarkers in Inflammatory Bowel Disease. Digestion. 2023;104(1):30-41.
• 26. Herrlinger KR, Dittmann R, Weitz G, Wehkamp J, Ludwig D, Schwab M, et al. Serum procalcitonin differentiates inflammatory bowel disease and self-limited colitis. Inflamm Bowel Dis. 2004;10(3):229-33.
• 27. De Vos M. Joint involvement associated with inflammatory bowel disease. Dig Dis. 2009;27(4):511-5. 28. Khan KJ, Ullman TA, Ford AC, Abreu MT, Abadir A, Marshall JK, et al. Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):661-73.