Fecal calprotectin as a marker of intestinal inflammation in pediatric cystic fibrosis patients.

UNLABELLED

The study aimed to evaluate fecal calprotectin levels as indicators of intestinal inflammation in children with cystic fibrosis while examining their relationship with clinical signs, genetic mutations, and therapeutic approaches. Due to the limited number of patients with certain mutation types and the heterogeneity of mutations, patients were grouped accordingly for the analysis of fecal calprotectin levels, in relation to genetic mutation categories. This single-centre study at Istanbul Medical Faculty included 45 cystic fibrosis patients (19 girls, 26 boys) aged 1-18 years and 45 age- and sex-matched healthy controls. We assessed fecal calprotectin levels, clinical features, genetic mutations, and laboratory parameters. Genetic mutations were categorized, and patients were grouped based on mutation types for analysis. The patient group showed significantly lower height Z-scores compared to controls (p < 0.007). Patients with cystic fibrosis had significantly higher fecal calprotectin levels (177.8 ± 3.0 µg/g) than controls (53.7 ± 2.2 µg/g) (p < 0.001). The levels of fecal calprotectin reached 537.7 ± 2.8 µg/g during pulmonary exacerbations but remained at 149.4 ± 2.8 µg/g during non-exacerbation periods (p = 0.012). The fecal calprotectin levels of patients taking pancreatic enzyme replacement therapy reached 245.3 ± 2.7 µg/g, whereas patients without this therapy had levels of 92.6 ± 2.9 µg/g (p = 0.005). The antibiotic users demonstrated higher fecal calprotectin levels (305.4 ± 3.1 µg/g vs 145.4 ± 2.9 µg/g), although the difference was not statistically significant (p = 0.074). The ΔF508 mutation carriers showed a trend of elevated fecal calprotectin levels (261.2 ± 3.4 µg/g) compared to homozygous polymorphism carriers (99.5 ± 3.6 µg/g), but the difference did not reach statistical significance (p = 0.082). The results of the sweat test showed a positive correlation with fecal calprotectin levels (r = 0.377, p = 0.020).

CONCLUSION

Our results show that bowel inflammation is problematic among children with cystic fibrosis, and fecal calprotectin is a useful marker. The peripheral zone effects become evident through elevated levels, which occur during pulmonary exacerbations and when patients receive pancreatic enzyme therapy. The degree of intestinal inflammation and fecal calprotectin levels vary depending on the type of genetic mutation in patients with cystic fibrosis.

WHAT IS KNOWN

• Cystic fibrosis causes inflammation in both respiratory and gastrointestinal systems. • Fecal calprotectin is a biomarker for detecting intestinal inflammation in pediatric diseases.

WHAT IS NEW

• Fecal calprotectin levels increase during pulmonary exacerbations and in children receiving pancreatic enzyme replacement therapy, indicating persistent intestinal inflammation. • Levels may also vary with CF genetic mutation types, but only a few studies have addressed this association. • Sweat test results correlate with intestinal inflammation, suggesting a broader role beyond diagnosis.