Fecal leukocyte esterase levels predict endoscopic severity as an alternative biomarker in inflammatory bowel disease
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Feng-Pai Tsai
,
Meng-Tzu Weng
,
Hsin-Yun Wu
,
Zhi-Che Chen
,
Chien-Chih Tung
,
Chun-Ying Wang
und
Shu-Chen Wei
Abstract
Objectives
Our previous study revealed a correlation between fecal leukocyte esterase and fecal calprotectin levels. This study assessed the predictive value of fecal leukocyte esterase compared with fecal calprotectin and C-reactive protein of inflammatory bowel disease.
Methods
Patients with inflammatory bowel disease who underwent ileocolonoscopy at National Taiwan University Hospital from March 2022 to March 2024 were included. Fecal leukocyte esterase and fecal calprotectin levels from stool samples collected within one month of endoscopy were analyzed. Active ulcerative colitis and Crohn’s disease were defined as Mayo endoscopic score ≥2 or simple endoscopic score for Crohn’s disease ≥7, respectively. Sensitivity, specificity, predictive values, and areas under the receiver operating characteristic curve were calculated using IBM SPSS Statistics 29.
Results
Of the 203 patients (100 with ulcerative colitis and 103 with Crohn’s disease), fecal leukocyte esterase levels were significantly correlated with fecal calprotectin levels (r=0.425, p<0.001) and endoscopic severity in ulcerative colitis (r=0.432, p<0.001) and Crohn’s disease (r=0.311, p=0.001). For predicting Mayo endoscopic scores ≥2 in ulcerative colitis using fecal leukocyte esterase, fecal calprotectin, and C-reactive protein, areas under the curve were 0.731, 0.785, and 0.558, respectively. For predicting simple endoscopic scores for Crohn’s disease ≥7, areas under the curve were 0.706, 0.800, and 0.770, respectively. No significant difference was observed between fecal leukocyte esterase and fecal calprotectin.
Conclusions
Fecal leukocyte esterase correlates with fecal calprotectin and predicts endoscopic severity in inflammatory bowel disease.
Funding source: Ministry of Science and Technology, Taiwan
Award Identifier / Grant number: 111-2314-B-002-188-MY3
Funding source: The Liver Disease Prevention and Treatment Research Foundation, Taiwan
Funding source: National Taiwan University Hospital
Award Identifier / Grant number: NTUH MS-507
Acknowledgments
We thank the staff of the Second Core Lab, Department of Medical Research, National Taiwan University Hospital for technical support during the study. We thank the staff of Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch for their assistance with the statistical analysis. This manuscript was edited by Wallace Academic Editing.
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Research ethics: This study was approved by the Institutional Review Board of National Taiwan University Hospital (IRB number: 202112116RINC). All protocols conformed to the ethical principles for medical research involving human patients outlined in the Declaration of Helsinki, which was updated in 2013.
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Informed consent: All the patients gave their written informed consent.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Conceptualization: FPT, MTW, SCW; Methodology: MTW, CYW, SCW; Investigation: FPT, MTW, HYW, ZCC, CCT, SCW; Data analysis: MTW, CYW; Data interpretation: All authors; Writing – original draft: FPT, MTW; Writing – review and editing: All authors; Approval: All authors.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: This work was supported by the grants from the Ministry of Science and Technology, Taiwan (111-2314-B-002-188-MY3 to SCW), National Taiwan University Hospital (NTUH MS-507 to SCW), and The Liver Disease Prevention and Treatment Research Foundation, Taiwan (to SCW and MTW).
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Data availability: The datasets analyzed during the current study are not publicly available due to privacy and ethical concerns but are available from the corresponding author on reasonable request.
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Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/cclm-2025-0747).
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