Abstract
With the increasing incidence and prevalence, Crohn’s disease (CD) has become one of the most challenging diseases in both diagnosis and treatment of gastroenterology. Evaluation of the disease activity and mucosal healing guides clinical decisions regarding subsequent therapy for CD. In this study, we enrolled a total of 144 patients with CD and 239 healthy controls were enrolled. Clinical characteristics and laboratory parameters of enrolled subjects were retrieved from the electronic medical record database of our hospital. Serum cytokine levels were measured by enzyme-linked immunosorbent assay (ELISA). Mucosa expression levels of inflammatory agents were measured by quantitative RT-PCR (qRT-PCR). We identified two neutrophil-based indexes, the neutrophil-to-albumin ratio (NAR) and neutrophil-to-bilirubin ratio (NBR), both of which had not yet been explored in CD or UC. NAR and NBR were significantly increased in patients with CD compared to those in healthy controls, and both indexes showed significantly positive correlations with CD activity and inflammatory load. In note, NAR and NBR showed better performance than blood neutrophil percentage, serum albumin, or bilirubin alone in these scenarios. More importantly, both NAR and NBR discriminated CD patients who completely or partially responded to infliximab (IFX) induction therapy from those with primary non-response. Our observations suggest that NAR and NBR may serve as promising biomarkers in the diagnosis and prediction of response to IFX therapy in CD.
Highlights
Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) is considered as a global health issue with its increasing incidence and prevalence [1]
Based on complete blood cell and serum biochemistry examinations, CD patients showed remarkably higher neutrophil percentage (NEU, 69.22 ± 9.76%, p < 0.0001) and lower serum ALB (35.68 ± 6.58 g/L, p < 0.0001), BIL (5.91 ± 2.05 mmol/L, p < 0.0001) levels compared to healthy controls (NEU, 55.47 ± 8.32%; ALB, 44.73 ± 2.51 g/L; BIL, 12.48 ± 5.66 mmol/L)
Creactive protein (CRP), as well as erythrocyte sedimentation rate (ESR), has been well-reported as disease activity biomarkers of IBD, and we found neutrophil-to-ALB ratio (NAR) and neutrophil-to-BIL ratio (NBR) were positively correlated with CRP and ESR
Summary
Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) is considered as a global health issue with its increasing incidence and prevalence [1]. Clinical remission has been traditionally considered as the initial goal of therapy for IBD, achievement of mucosal healing is regarded to be the therapeutic goal with advances in methods for disease assessment [2, 3]. Evaluation of the disease activity and mucosal healing guides clinical decisions regarding subsequent therapy for IBD. Biomarkers in IBD are able to help monitor disease activity in clinical practice. Efforts have been made to differentially diagnose IBD from functional bowel disease, monitor disease activity, and predict therapeutic effect, recurrence, prognosis by blood and stool tests, such as erythrocyte sedimentation rate (ESR), Creactive protein (CRP) and fecal calprotectin [8–11]. Aside from currently available biomarkers, most of which deliver suboptimal performance, gastrointestinal endoscopy remains the most powerful tool to monitor the inflammatory activity of IBD. To better manage IBD, the search for reliable and non-invasive biomarkers that can be accessible and cost-effective is necessary and urgent
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