Fecal Calgranulin C Versus Fecal Calprotectin as Non- Invasive Biomarkers in Predicting Activity and Severity of Ulcerative Colitis Compared to Colonoscopy

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease described by periods of relapse and remission. Monitoring disease activity typically requires invasive procedures like a colonoscopy. Fecal biomarkers like calprotectin and calgranulin C have emerged as non-invasive alternatives. Aim: To compare fecal calgranulin C and fecal calprotectin in predicting disease activity and severity in cases with ulcerative colitis. Patients and Methods: This prospective open-label research included 50 UC cases treated at Al-Azhar University hospitals from June 2024 to May 2025. Each patient was assessed during both active and remission phases using clinical evaluation, laboratory testing, colonoscopy, histopathology, and measurement of fecal calprotectin and calgranulin C levels via ELISA. Cases have been separated into Group I (active UC) and Group II (remission). Results: Fecal calgranulin C and calprotectin levels have been significantly elevated in active UC than in remission (P ≤ 0.001). Both markers positively correlated with inflammatory indicators (NLR, ESR, CRP) and negatively with serum albumin. Calgranulin C showed stronger correlation coefficients. ROC analysis revealed calgranulin C had a sensitivity of 92% and specificity of 88% (AUC=0.960), compared to calprotectin with 92% sensitivity and 76% specificity (AUC=0.944). Both biomarkers significantly increased with endoscopic and histological severity. Conclusion: Fecal calgranulin C demonstrated higher specificity than calprotectin and closely reflected disease activity and severity in UC. It may serve as a superior non-invasive biomarker for follow-up UC.