Abstract
BackgroundActive and severe ulcerative colitis (UC) and non-response to 5-aminosalicylic acid (5-ASA) are related to poor outcomes and should be accurately identified. Several integrated inflammatory indexes are potentially useful to assess the disease severity in patients with acute or critical diseases but are underexplored in patients with UC.MethodsPatients with UC consecutively admitted to our hospital between January 2015 and December 2020 were retrospectively grouped according to the activity and severity of UC and response to 5-ASA. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), neutrophil-to-platelet ratio (NPR), platelet-to-albumin ratio (PAR), C-reactive protein-to-albumin ratio (CAR), and C-reactive protein-to-lymphocyte ratio (CLR) were calculated. The areas under receiver operating characteristic curves (AUC) were calculated.ResultsOverall, 187 patients with UC were included, of whom 151 were active, 55 were severe, and 14 were unresponsive to 5-ASA. The active UC group had significantly higher NLR, PLR, SII, and PAR levels. SII had the greatest predictive accuracy for active UC, followed by PLR, PAR, and NLR (AUC = 0.647, 0.641, 0.634, and 0.626). The severe UC group had significantly higher NLR, PLR, SII, PAR, CAR, and CLR levels. CLR had the greatest predictive accuracy for severe UC, followed by CAR, PLR, SII, NLR, and PAR (AUC = 0.732, 0.714, 0.693, 0.669, 0.646, and 0.63). The non-response to the 5-ASA group had significantly higher CAR and CLR levels. CAR had a greater predictive accuracy for non-response to 5-ASA than CLR (AUC = 0.781 and 0.759).ConclusionSII, CLR, and CAR may be useful for assessing the severity and progression of UC, but remain not optimal.
Highlights
Ulcerative colitis (UC) is a relapsing and remitting mucosal inflammation often restricted to the colon and rectum, which may be associated with dysregulated immune response [1]
Patients with ulcerative colitis (UC) consecutively admitted to our hospital between January 2015 and December 2020 were retrospectively grouped according to the activity and severity of UC and response to 5-aminosalicylic acid (5-ASA)
systemic immune-inflammation index (SII), C-reactive protein-to-lymphocyte ratio (CLR), and C-reactive protein-toalbumin ratio (CAR) may be useful for assessing the severity and progression of UC, but remain not optimal
Summary
Ulcerative colitis (UC) is a relapsing and remitting mucosal inflammation often restricted to the colon and rectum, which may be associated with dysregulated immune response [1]. Active UC is usually classified into mild, moderate, and severe according to the recommendation by the international guideline [4]. Medications can avoid the progression from mild-moderate to severe UC [7]. 5-aminosalicylic acid (5ASA) is the first-line choice of medication for patients with UC diagnosed within the first year [8]. Patients with severe UC are not well responsive to 5-ASA, leading to the use of corticosteroids, immunosuppressants, and biologics [9–12]. Active and severe ulcerative colitis (UC) and non-response to 5-aminosalicylic acid (5-ASA) are related to poor outcomes and should be accurately identified.
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