We studied the activity assessment of ulcerative colitis and Crohn's disease by 5 acute phase reactants: C-reactive protein (CRP), (alpha-1-acid glycoprotein, alpha-1 antitrypsin, haptoglobin and fibrinogen. From a large register of patients with inflammatory bowel disease (IBD) we chose randomly 91 patients: 61 with ulcerative colitis and 30 with Crohn's disease. As a reference point in the disease activity assessment we used standard clinical indices. Statistical analysis was performed by non-parametric methods: the Kruskal-Wallis and Fisher's exact test. The disease activity assessment in patients with ulcerative colitis by the index according to Powell-Tuck indicated that the patients with active disease (N = 19) had significantly higher levels of all acute phase proteins mentioned above except fibrinogen (alpha < 0.05 to 0.001) than patients in remission (N = 42). Analysis of the same data by Fisher's exact test indicated that there had been a probability for all the proteins measured to be higher than the normal values, particularly CRP (p < 10(-8)) and the other somewhat less. In patients with Crohn's disease, the disease activity assessment was performed by 2 indices. According to "The Crohn's Disease Activity Index" (CDAI), only (alpha-1 acid glycoprotein and haptoglobin (alpha < 0.05) were higher in patients with active disease (N = 4) than in patients with remission (N = 26). Analysis of the same data by the Fisher's exact test indicated that the sample had probably not been representative, because in the active form of the disease one could expect all the 5 parameters to be above normal values, i.e. for CRP and alpha-1 antitrypsin with alpha < 0.01 and for the others with alpha < 0.05. According to the van Hees Index there was no patient in remission, 17 patients were in partial remission and 13 patients had active disease. According to the Kruskal-Wallis test patients with the active disease had significantly higher concentrations of haptoglobin (alpha < 0.001), CRP (alpha < 0.01), alpha-1-antitrypsin and fibrinogen (alpha < 0.05). According to Fisher's exact test, CRP and haptoglobin (alpha < 0.01) and also alpha-1 antitrypsin (alpha < 0.05) were expected to be above normal values, that had not been proven for alpha-1 acid glycoprotein and fibrinogen. Our results confirm that there is not single ideal parameter for IBD activity assessment, but indicate that these 5 acute phase reactants, together with other variables, could be useful in a more precise IBD activity assessment.
