Accuracy of the highly sensitive C-reactive protein/albumin ratio to determine disease activity in inflammatory bowel disease

Role of serological biomarkers in evaluating and predicting endoscopic activity in inflammatory bowel disease

BACKGROUND

Diagnosis of inflammatory bowel disease and assessment of disease activity are fundamentally reliant on endoscopy. Nonetheless, it is costly and invasive, highlighting the necessity for more accessible and non-invasive biomarkers to assist in the diagnosis and evaluation of inflammatory bowel disease.

AIM

To examine the correlation of biomarkers with endoscopic activity, evaluate their diagnostic significance, and develop models to forecast endoscopic activity.

METHODS

We performed a retrospective single-center analysis of 365 patients with ulcerative colitis (UC), 319 with Crohn’s disease (CD) and 100 controls at the First Affiliated Hospital of Zhengzhou University from January 2022 to September 2024. The following biomarkers were analyzed: White blood cell, hemoglobin (Hb), platelet (PLT), neutrophil (N), lymphocyte (L), hematocrit (HCT), eosinophil, albumin (ALB), globulin (GLB), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ALB/GLB (AGR), CRP/ALB (CAR), CRP/L (CLR), PLT/ALB (PAR), PLT/L (PLR), and N/L (NLR).

RESULTS

Serum N, PLT, GLB, CRP, ESR, CAR, CLR, PLR, PAR, and NLR levels were significantly elevated (P < 0.001 or P < 0.05) in the UC and CD groups compared to controls, whereas Hb, HCT, L, ALB, and AGR were reduced (P < 0.001 or P < 0.05). Aside from L and eosinophil, substantial differences were observed between mild and severe activity in UC and CD (P < 0.001 or P < 0.05). UC and CD patients who exhibited an endoscopic response after 14 weeks of treatment had elevated CRP, CAR, and CLR levels at baseline compared to endoscopic nonresponders (P < 0.01 or P < 0.05). The UC nomogram model utilizing ESR, CAR, and PAR, along with the CD nomogram model employing AGR and PAR, demonstrate predictive significance and clinical applicability for assessing endoscopic activity.

CONCLUSION

White blood cell, Hb, HCT, PLT, N, CRP, ESR, ALB, GLB, AGR, CAR, CLR, PLR, PAR and NLR are significantly correlated with the endoscopic activity of UC and CD. Patients with UC and CD exhibiting elevated CRP, CAR, and CLR levels are more inclined to respond to treatment. Our nomogram models can precisely forecast endoscopic activity.

Development and Validation of Predictive Models for Inflammatory Bowel Disease Diagnosis: A Machine Learning and Nomogram-Based Approach

Background

Inflammatory bowel disease (IBD) is a chronic, incurable gastrointestinal disease without a gold standard for diagnosis. This study aimed to develop predictive models for diagnosing IBD, Crohn's disease (CD), and Ulcerative colitis (UC) by combining two approaches: machine learning (ML) and traditional nomogram models.

Methods

 Cohorts 1 and 2 comprised data from the UK Biobank (UKB), and the First Hospital of Jilin University, respectively, which represented the initial laboratory tests upon admission for 1135 and 237 CD patients, 2192 and 326 UC patients, and 1798 and 298 non-IBD patients. Cohorts 1 and 2 were used to create predictive models. The parameters of the machine learning model established by Cohorts 1 and 2 were merged, and nomogram models were developed using Logistic regression. Cohort 3 collected initial laboratory tests from 117 CD patients, 197 UC patients, and 241 non IBD patients at a tertiary hospital in different regions of China for external testing of three nomogram models.

Results

For Cohort 1, ML-IBD-1, ML-CD-1 and ML-UC-1 models developed using the LightGBM algorithm demonstrated exceptional discrimination (ML-IBD-1: AUC = 0.788; ML-CD-1: AUC = 0.772; ML-UC-1: AUC = 0.841). For Cohort 2, ML-IBD-2, ML-CD-2, and ML-UC-2 models developed using XGBoost and Logistic Regression algorithms demonstrated exceptional discrimination (ML-IBD-2: AUC = 0.894; ML-CD-2: AUC = 0.932; ML-UC-2: AUC = 0.778). The nomogram model exhibits good diagnostic capability (nomogram-IBD: AUC=0.778, 95% CI (0.688-0.868); nomogram-CD: AUC=0.744, 95% CI (0.710-0.778); nomogram-UC, AUC=0.702, 95% CI (0.591-0.814)). The predictive ability of the three models was validated in cohort 3 (nomogram-IBD: AUC=0.758, 95% CI (0.683-0.832); nomogram-CD: AUC=0.791, 95% CI (0.717-0.865); nomogram-UC, AUC=0.817, 95% CI (0.702-0.932)).

Conclusion

This study utilized three cohorts and developed risk prediction models for IBD, CD, and UC with good diagnostic capability, based on conventional laboratory data using ML and nomogram.

Review Article: Albumin and Its Role in Inflammatory Bowel Disease: The Old, the New, and the Future

BACKGROUND

Circulating albumin concentrations are frequently measured in clinical practice. This review explores biochemical properties and physiological roles of albumin, its place in nutritional assessment, current understanding of perturbed circulating concentrations, and role in clinical management, with special focus on patients with inflammatory bowel disease (IBD).

METHODS

A detailed literature search was performed.

RESULTS

Albumin is synthesized by hepatocytes and comprises 3% of total body protein. It has a prolonged intravascular half-life (17-19 h) due to neonatal Fc-receptor-mediated salvage and has a multitude of physiological functions. Albumin homeostasis is affected in disease states often resulting in reduced level, which is not a direct marker of malnutrition. In patients with IBD, morbid albumin concentrations provide prognostic information, identification of nonintestinal conditions, guidance to the required aggressiveness of therapy and biologic dosage, monitoring of disease activity, and potential need for therapeutic escalation. Barriers to utilization of morbid albumin levels include the lack of consensus regarding cutoff values and the deficiency of high-quality data in this domain due to the retrospective design of the majority of studies. Serum levels hold greatest clinical potential in prognostication in acute severe ulcerative colitis. The premorbid level in the individual may provide insight into dosing of biologics and potentially enhance interpretation of morbid levels.

CONCLUSIONS

Understanding the physiology and pathophysiology of albumin is fundamental to interpreting its circulating levels. The clinical value of its measurement in patients with IBD may be undervalued, as it assists in evaluation of disease severity, prognosis, and therapeutic decision-making.

Systemic Immune-Inflammation Index: A Promising, Non-Invasive Biomarker for Crohn's Disease Activity and Severity Assessment

Purpose

Crohn's disease (CD) is a chronic inflammatory disorder with periods of exacerbation and remission. We aim to evaluate the systemic immune-inflammation index (SII) as a prognostic biomarker in CD and its utility in predicting disease activity and severity.

Patients and Methods

This retrospective study analyzed CD patients using the Harvey-Bradshaw index (HBI) for disease stratification and the Simple Endoscopic Score for Crohn's Disease (SES-CD) for post-treatment evaluation. Data analysis was conducted using R software. Serological indices underwent predictive analysis through the receiver operating characteristic (ROC) curve. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression identified independent prognostic factors to construct nomograms. Model validation was performed using the Concordance index (C-index), calibration analysis and decision curve analysis (DCA).

Results

In this study, 254 patients with Crohn's disease (CD) were enrolled, including 171 males and 83 females, with ages ranging from 13 to 74. SII was significantly elevated in active CD (p<0.001), correlating with disease severity (p<0.001). Although SII decreased in patients with mucosal healing (p<0.001), its prognostic accuracy (AUC=0.719) was lower than other biomarkers. However, SII emerged as an independent predictor for CD activity and severity with higher efficacy (AUC=0.774 and 0.807). The CD activity and severity prediction nomograms showed high C-indices (0.8038 and 0.8208), indicating strong predictive performance.

Conclusion

SII is a valuable biomarker for assessing CD severity and monitoring mucosal healing post-treatment. The SII-based nomograms offer a reliable model for evaluating CD progression, aiding in personalized treatment approaches and enhancing clinical decision-making. We recommend randomized controlled trials (RCTs) or studies with larger sample sizes to improve the model.

Absolute monocyte counts could predict disease activity and secondary loss of response of patients with Crohn's disease treated with anti-TNF-α drug

BACKGROUND

Assessing Crohn's disease (CD) activity is critical for monitoring disease progression. In CD, monocytes could release TNF-α. Thus, it is extremely important to study its role in the disease activity and loss of response to anti-TNF-α biologics.

METHODS

In this study, we collected CD patients treated with biologics from January 2017 to May 2022. Indicators associated with disease activity were evaluated by Spearman correlation analysis and Mann-Whitney U test. Specifically, logistic analyses were used to explore the predictors of primary nonresponse (PNR) and secondary loss of response (SLOR) within 1 year of anti-TNF-α agents. In addition, a nomogram was developed for therapeutic effect prediction.

RESULTS

283 patients with CD were identified. Disease activity group, defined as CDAI equal to or greater than 150, had significant elevated absolute monocyte counts than disease remission group based on CDAI score (p = 0.019, Z = -2.354). Logistic analyses showed that absolute monocyte counts could be an independent predictor of 1-year SLOR of anti-TNF-α agents in CD patients (p = 0.013). A nomogram established based on gender, absolute monocyte counts, and hemoglobin could predict SLOR within 1 year of anti-TNF-α agents reliably.

CONCLUSION

The results of this study support the utility of absolute monocyte counts detecting disease activity and anti-TNF-α therapy effect in patients with CD.

C-reactive protein-to-albumin ratio and neutrophil-to-albumin ratio for predicting response and prognosis to infliximab in ulcerative colitis

The C-reactive protein-to-albumin ratio (CAR) and neutrophil-to-albumin ratio (NAR) serve as established markers for inflammatory diseases. However, limited studies have investigated their potential in predicting response and prognosis following infliximab (IFX) treatment. The objective of this paper was to evaluate feasibility of CAR and NAR as biomarkers to assess response to IFX induction therapy. Additionally, we attempted to determine the capacity to predict clinical remission in ulcerative colitis (UC) after 54 weeks of IFX treatment. We enrolled a total of 157 UC patients diagnosed via endoscopic mucosal biopsy at our hospital between October 2018 and June 2023. Additionally, 199 patients presenting with gastrointestinal symptoms, who underwent physical examinations, constituted the control group. Comprehensive clinical data, laboratory indicators, and endoscopic findings were systematically collected. CAR and NAR values were computed before treatment, post-induction, and subsequently at 8-week intervals. Comparisons between two groups were analyzed using the Wilcoxon rank-sum test or the independent samples t-test, and comparisons between multiple groups were analyzed using the one-way ANOVA (analysis of variance) or the Kruskal-Wallis rank sum test. We found CAR and NAR emerged as sensitive biomarkers for assessing disease activity. Notably, our findings indicated their dual predictive capability: foreseeing response post-IFX induction therapy and prognosticating the likelihood of UC patients achieving clinical remission following 54 weeks on IFX therapy.

High-sensitivity C-reactive protein level in stable-state bronchiectasis predicts exacerbation risk

BACKGROUND

Elevation of systemic inflammatory markers were found to correlate with increased disease extent, reduced lung function and higher risk of future severe exacerbations in patients with bronchiectasis. Although a significant correlation of circulating hs-CRP levels with HRCT scores and resting oxygen saturation in patients with stable-state non-cystic fibrosis (CF) bronchiectasis was suggested, there is little data on the relationship between hs-CRP and the prognosis of bronchiectasis and a lack of data on the role of hs-CRP in predicting bronchiectasis exacerbation.

METHODS

A prospective study was conducted on Chinese patients with non- CF bronchiectasis from 1st October to 31st December 2021. Baseline serum hs-CRP were obtained at stable-state. The follow-up period lasted for one year. Co-primary endpoints were the development of any bronchiectasis exacerbation and hospitalized bronchiectasis exacerbation.

RESULTS

Totally 123 patients were included. Higher hs-CRP was associated with increased risk to develop any bronchiectasis exacerbation, adjusted odds ratio (aOR) of 2.254 (95% CI = 1.040-4.885, p = 0.039), and borderline significantly increased hospitalized bronchiectasis exacerbation with aOR of 1.985 (95% CI = 0.922-4.277, p = 0.080).

CONCLUSION

Baseline serum hs-CRP level at stable-state can predict risk of bronchiectasis exacerbation, which is reflecting chronic low-grade inflammation in bronchiectasis.

C-reactive protein/albumin ratio and IL-6 are associated with disease activity in patients with ulcerative colitis

BACKGROUND

Cytokines are key mediators of the inflammation in ulcerative colitis (UC); there are inconsistent data on cytokines profile in patients with UC. C-reactive protein/albumin ratio (CRP/ALB) has also been found as an inflammatory indicator. However, the role of CRP/ALB in UC remains unclear. We aimed to evaluate the CRP/ALB ratio and cytokines profile in patients with UC. We further explore the association between CRP/ALB and inflammatory markers, such as erythrocyte sedimentation rate (ESR), fecal calprotectin (FC) and cytokines.

METHODS

One hundred thirty UC patients and 65 controls were included in the study. Clinical and laboratory findings were retrospectively reviewed; differences in variables between two groups were examined using the Mann-Whitney U-test. The association between CRP/ALB, cytokines, and clinical parameters was determined by Spearman's correlation test.

RESULTS

CRP/ALB levels were significantly elevated in active UC patients. The optimal cutoff level of the CRP/ALB was 0.083. The patients with active UC had a median interleukin-6 (IL-6) level of 7.715 pg/ml (interquartile ranges, IQR 3.475-14.63), which was significantly higher than those in remission (2.95 pg/ml, IQR 2.17-5.44) (p < 0.001). Positive correlations between CRP/ALB and inflammatory markers were also observed.

CONCLUSIONS

Our results suggest that CRP/ALB and IL-6 could be potential biomarkers for assessment of clinical activity in Chinese patients with UC.

The value of 7 peripheral blood serum ratios in diagnosis and prediction of disease activity of patients within inflammatory bowel disease individuals

Objective

In recent years, a number of studies have suggested that inflammation-based biomarkers can be applied in the diagnostics and prognostic testing of disease. However, the association between these ratios and inflammatory bowel disease (IBD) remains unclear. We aimed to investigate the role of these inflammation-based ratios in patients with IBD.

Methods

Retrospective analysis of 362 patients with IBD and 100 healthy individuals from January 2016 and December 2021. The receiver operating characteristic curve and logistic regression analysis was applied to explore the diagnostic and predictive performance of the seven ratio markers [neutrophil- to-albumin ratio (NAR), neutrophil-to-pre-albumin ratio (NPAR), albumin-to-alkaline-phosphatase ratio (AAPR), albumin-to-globulin ratio (AGR), albumin-to-fibrinogen ratio (AFR), fibrinogen-to-pre-albumin ratio (FPR), and Prognostic Nutritional Index (PNI)] regarding to disease activity in IBD individuals.

Results

Compared with healthy controls, patients with Crohn's disease (CD) or ulcerative colitis (UC) exhibited higher levels of NAR, NPAR, FPR (P < 0.001), lower levels of AAPR, and PNI (P < 0.001). Multivariate logistic regression showed that the level of NPAR (OR = 1.12, 95%CI: 1.02-1.23, P = 0.016) and AGR (OR = 1.01, 95%CI: 1.01-1.12, P < 0.001) was an independent risk factor of IBD. Then, we found the level of NPAR (OR = 1.10, 95%CI: 1.01-1.20, P = 0.02) and PNI (OR = 0.83, 95%CI: 0.71-0.96, P = 0.01) was independently associated with disease activity. Besides, a positive association was observed between the level of NPAR and two clinical scores [Harvey Bradshaw index (HBI) in patients with CD, Mayo score in patients with UC]. Finally, the level of NPAR (P = 0.002) and PNI (P = 0.003) showed a significant difference in the IBD-associated neoplasia group and IBD without neoplasia group.

Conclusion

Our data first suggests NPAR as a putative biomarker for diagnosing and predicting disease activity in patients with IBD. Investigations involving a larger number of IBD individuals are necessary to validate its use as an easily obtained peripheral blood biomarker of IBD.