Utilidad de la calprotectina sérica como biomarcador de actividad inflamatoria en la enfermedad inflamatoria intestinal / The use of serum calprotectin as a biomarker for inflammatory activity in inflammatory bowel disease

Introducción: para el correcto manejo de la enfermedad inflamatoria intestinal (EII) precisamos de marcadores no invasivos, fiables y sencillos que permitan detectar la actividad inflamatoria de forma precoz. Uno de estos marcadores biológicos podría ser la calprotectina sérica (CS). Material y métodos: inclusión prospectiva de pacientes con EII que iban a realizarse una colonoscopia por práctica clínica habitual. Se determinaron: CS, calprotectina fecal (CF) y parámetros analíticos convencionales. Se realizaron los índices clínicos (Harvey y Walmsley) así como los endoscópicos correspondientes en cada escenario (Simple Endoscopic Score Crohn Disease [SES-CD] y Mayo). Resultados: se incluyeron 53 pacientes; el 51% (27 pacientes) con colitis ulcerosa (CU) y el 49% (26 pacientes) con enfermedad de Crohn (EC). En CU los valores de CS fueron significativamente superiores con actividad endoscópica Mayo 2/3 (mediana 10,39 mg/ml [IQR: 7,4-12,2]) frente aquellos con Mayo 0/1 (mediana 4,07mg/ml [IQR: 2,9-7,2]) (p = 0,01). El área bajo la curva ROC (AUCROC) fue 0,85, obteniendo para un punto de corte de CS de 4,4 mg/dl una sensibilidad y especificidad del 83,3% y 81,25%, respectivamente. Además, al comparar con otros marcadores serológicos de actividad (proteína C reactiva [PCR], velocidad de sedimentación globular [VSG], hemoglobina [Hb] y plaquetas) se obtuvo un AUCROC superior. Cuando comparamos la CS con los hallazgos endoscópicos en EC, no hubo diferencias estadísticamente significativas (SES CD > 3: 20,1 [IQR: 16,8-23,4] vs. SESC ≤ 3:6,25 [IQR: 5,4-7,1]) (p = 0,8). Conclusiones: la CS es un buen marcador indirecto de la actividad inflamatoria y existe correlación con los hallazgos endoscópicos en CU, aunque sin diferencias estadísticamente significativas en EC

Introduction: simple, reliable and non-invasive biomarkers are needed to enable the early detection of inflammatory activity for the correct management of inflammatory bowel disease (IBD). One of these biomarkers may be serum calprotectin (SC). Material and methods: a prospective study was performed of patients with IBD due to undergo a colonoscopy as part of the common clinical practice. The study parameters included SC, fecal calprotectin (FC) and conventional blood test parameters. Clinical indices (Harvey and Walmsley) and relevant endoscopic scores were completed for each scenario (Simple Endoscopic Score Crohn Disease [SES-CD] and Mayo). Results: fifty-three patients were included in the study, 51% (27 patients) with ulcerative colitis (UC) and 49% (26 patients) with Crohn's disease (CD). The CS values in UC were significantly higher with an endoscopic Mayo score 2/3 (median score 10.39 mg/ml [IQR: 7.4-12.2]) compared to those with a Mayo score of 0/1 (median 4.07 mg/ml [IQR: 2.9-7.2]) (p = 0.01). The area under the ROC curve (AUCROC) was 0.85 and the sensitivity and specificity were 83.3% and 81.25%, respectively, for a SC cut-off point of 4.4 mg/dl. Furthermore, a higher AUCROC was obtained in comparison with other serological markers for activity (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], hemoglobin [Hb] and platelets). There were no statistically significant differences in the comparison between SC and endoscopic findings in CD (SES CD > 3: 20.1 [IQR: 16.8-23.4] vs SESC ≤ 3:6.25 [IQR: 5.4-7.1]) (p = 0.8). Conclusions: SC is a good indirect marker of inflammatory activity and there was a correlation with endoscopic findings in UC. However, there were no statistically significant differences in the case of CD

The use of serum calprotectin as a biomarker for inflammatory activity in inflammatory bowel disease.

INTRODUCTION: simple, reliable and non-invasive biomarkers are needed to enable the early detection of inflammatory activity for the correct management of inflammatory bowel disease (IBD). One of these biomarkers may be serum calprotectin (SC). MATERIAL AND METHODS: a prospective study was performed of patients with IBD due to undergo a colonoscopy as part of the common clinical practice. The study parameters included SC, fecal calprotectin (FC) and conventional blood test parameters. Clinical indices (Harvey and Walmsley) and relevant endoscopic scores were completed for each scenario (Simple Endoscopic Score Crohn Disease [SES-CD] and Mayo). RESULTS: fifty-three patients were included in the study, 51% (27 patients) with ulcerative colitis (UC) and 49% (26 patients) with Crohn's disease (CD). The CS values in UC were significantly higher with an endoscopic Mayo score 2/3 (median score 10.39 mg/ml [IQR: 7.4-12.2]) compared to those with a Mayo score of 0/1 (median 4.07 mg/ml [IQR: 2.9-7.2]) (p = 0.01). The area under the ROC curve (AUCROC) was 0.85 and the sensitivity and specificity were 83.3% and 81.25%, respectively, for a SC cut-off point of 4.4 mg/dl. Furthermore, a higher AUCROC was obtained in comparison with other serological markers for activity (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], hemoglobin [Hb] and platelets). There were no statistically significant differences in the comparison between SC and endoscopic findings in CD (SES CD > 3: 20.1 [IQR: 16.8-23.4] vs SESC ≤ 3:6.25 [IQR: 5.4-7.1]) (p = 0.8). CONCLUSIONS: SC is a good indirect marker of inflammatory activity and there was a correlation with endoscopic findings in UC. However, there were no statistically significant differences in the case of CD.

Síndrome de secreción inadecuada de hormona antidiurética postquimioembolización transarterial de un carcinoma hepatocelular / Syndrome of inappropriate antidiuretic hormone secretion following transarterial chemoembolisation of hepatocellular carcinoma

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Vasculitis leucocitoclástica asociada a enfermedad de Crohn / Leukocytoclastic vasculitis associated with Crohn's disease

En el curso de la enfermedad inflamatoria intestinal pueden aparecer múltiples manifestaciones extraintestinales, y las cutáneas son bastante habituales tanto en la colitis ulcerosa como en la enfermedad de Crohn. El pioderma gangrenoso y el eritema nodoso son las más frecuentes, y existen otras manifestaciones cutáneas muy poco frecuentes, como la vasculitis leucocitoclástica. Presentamos el caso de un paciente en el que se diagnosticó de forma simultánea la enfermedad de Crohn y la vasculitis cutánea, con mejoría clínica significativa de ambos cuadros tras instaurar tratamiento con corticoides (AU)

In the course of inflammatory bowel disease (IBD) a number of extraintestinal manifestations are known to occur, being the dermatological ones often associated to both ulcerative colitis and Crohn's disease. Pyoderma gangrenosum and erythema nodosum are the most frequent, but there are other skin manifestations less frequently reported such as leukocytoclastic vasculitis. We present a case, in which Crohn's disease and leukocytoclastic vasculitis were simultaneously diagnosed, and corticoids treatment achieved complete remission of the both cutaneous and gastrointestinal manifestations (AU)

[Leukocytoclastic vasculitis associated with Crohn's disease]. / Vasculitis leucocitoclástica asociada a enfermedad de Crohn.

In the course of inflammatory bowel disease (IBD) a number of extraintestinal manifestations are known to occur, being the dermatological ones often associated to both ulcerative colitis and Crohn's disease. Pyoderma gangrenosum and erythema nodosum are the most frequent, but there are other skin manifestations less frequently reported such as leukocytoclastic vasculitis. We present a case, in which Crohn's disease and leukocytoclastic vasculitis were simultaneously diagnosed, and corticoids treatment achieved complete remission of the both cutaneous and gastrointestinal manifestations.