{"doi":"10.1093/crocol/otae016","title":"American Gastroenterological Association-Proposed Fecal Calprotectin Cutoff of 50 ug/g is Associated With Endoscopic Recurrence in a Real-World Cohort of Patients With Crohn’s Disease Post-ileocolic Resection","abstract":"Abstract Background Fecal calprotectin (FC) is a reliable predictor of active bowel inflammation in postoperative Crohn’s disease (CD), but cutoffs vary between studies. Recent guidelines recommend a cutoff of <50 ug/g to avoid routine endoscopy in patients at low pretest probability for CD recurrence. We evaluated the performance of this threshold in a real-world CD cohort after ileocolic resection (ICR). Methods In this retrospective study, patients with CD post-ICR between 2009 to 2020 with FC > 60 days but < 1 year of surgery were included from a multicenter database. Established risk factors and/or biologic prophylaxis (biologic within 90 days of surgery) defined pretest probability. Those without postoperative colonoscopy were excluded. Rates of endoscopic recurrence, defined as Rutgeerts score ≥ i2b at any time after surgery, were compared between FC < 50 versus ≥ 50 ug/g. Student’s t-test and Fisher’s exact test were utilized for statistical analysis. All postoperative FCs were matched to closest colonoscopy within 1 year to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results Thirty-seven patients categorized as either low-risk or high-risk and received biologic prophylaxis and had postoperative colonoscopy were included. Median time to first FC was 217 days (IQR 131–288). 15 (41%) patients had initial FC < 50 ug/g versus 22 (59%) ≥50 ug/g. Median time to first colonoscopy was 234 days (IQR 189–369). Compared to initial FC ≥ 50 ug/g, FC < 50ug/g experienced less endoscopic recurrence (0% vs. 36%, P = .005). Median time to first endoscopic recurrence in FC ≥ 50 ug/g was 145 days. There were 39 matched pairs of FC and colonoscopy. At an FC cutoff of 50 ug/g, calculated sensitivity was 90% and NPV was 93%, whereas specificity and PPV were 48% and 38%, respectively. Conclusions In this real-world cohort, FC < 50 ug/g is a useful cutoff to exclude endoscopic recurrence in a post-ICR CD population that is at low pretest probability of recurrence.","journal":"Crohn s & Colitis 360","year":2024,"id":475074,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9529,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":460563,"name":"Ravi S. Shah","orcid":"0000-0002-5001-860X","position":1,"is_corresponding":false},{"id":460568,"name":"Benjamin Click","orcid":"0000-0003-2582-2812","position":2,"is_corresponding":false},{"id":462182,"name":"Benjamin L Cohen","orcid":null,"position":3,"is_corresponding":false},{"id":280893,"name":"Edward L. Barnes","orcid":"0000-0001-9894-8796","position":4,"is_corresponding":false},{"id":927569,"name":"Abel Joseph","orcid":"0000-0002-5446-6127","position":5,"is_corresponding":false},{"id":460564,"name":"Salam Bachour","orcid":"0000-0002-0226-7513","position":6,"is_corresponding":false},{"id":307990,"name":"Jessica Hu","orcid":"0000-0002-7241-3280","position":7,"is_corresponding":false},{"id":1312254,"name":"Susell Contreras","orcid":null,"position":8,"is_corresponding":false},{"id":859351,"name":"Elizabeth Li","orcid":"0000-0001-5961-2894","position":9,"is_corresponding":false},{"id":345072,"name":"Jordan E. Axelrad","orcid":"0000-0003-1951-7790","position":10,"is_corresponding":false},{"id":870007,"name":"Terry Li","orcid":"0000-0001-5629-4763","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T02:06:16.992586Z","pmid":"38525200","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}