A Novel Neutrophil-Based Biomarker to Monitor Disease Activity and Predict Response to Infliximab Therapy in Patients With Ulcerative Colitis

Abstract

BackgroundUlcerative colitis (UC) is characterized by refractory and recurrent mucosal inflammation, leading to a substantial healthcare burden. Diagnostic biomarkers predicting disease activity and treatment response remain elusive. To evaluate the application value of a novel neutrophil-based index (the neutrophil-to-albumin ratio, NAR) as a novel diagnostic biomarker in patients with UC and a predictive marker for disease activity and response to infliximab (IFX) therapy.MethodsClinical characteristics and laboratory parameters of enrolled subjects (patients with UC and healthy controls) were retrieved from the electronic medical record database of our hospital. Serum cytokine and fecal calprotectin levels were measured by enzyme-linked immunosorbent assay (ELISA). Mucosal expression levels of inflammatory agents were measured by quantitative RT-PCR (qRT-PCR).ResultsWe found that NAR, which had not yet been explored in UC, was significantly increased in patients with UC (n = 146) compared to that in controls (n = 133) (1.95 ± 0.41 vs. 1.41 ± 0.23, p < 0.0001). NAR showed a positive association with the disease activity and inflammatory load in patients with UC. Pre-treatment NAR was significantly lower in IFX responders than that in non-responders (2.18 ± 0.29 vs. 2.44 ± 0.21, p = 0.0118), showing a significant ability to discriminate initial responders from primary non-responders to IFX induction therapy (AUC = 0.7866, p = 0.0076). Moreover, pre-treatment NAR predicted postinduction serum IFX trough level.ConclusionOur study provides evidences to utilize NAR in the diagnosis, activity monitoring, and IFX response prediction in patients with UC.

The Neutrophil-to-Albumin Ratio (NAR): A Novel Index in Relation to Clinical Symptoms, Quality of Life, and Psychological Status in Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D)

“…NAR has been observed to be significantly increased in patients with IBD, and it has shown positive correlations with both systemic and mucosal inflammation. 9,11 In this study, we underscored the clinical significance of NAR as a biomarker in IBS. Its associations with symptom severity, quality of life (QOL), and inflammatory mediators highlight its potential in guiding treatment strategies and improving patient outcomes.…”

“…15 This well-established assessment tool allows for a thorough evaluation of depressive symptoms. The distribution of PHQ-9 scores was categorized into 5 levels: Minimal (0-4), Mild (5-9), Moderate (10)(11)(12)(13)(14), Moderately severe (15)(16)(17)(18)(19), Severe (20)(21)(22)(23)(24)(25)(26)(27). In our follow-up study, a decline in PHQ-9 distribution levels was considered as "improvement in PHQ-9".…”

“…The neutrophil-to-albumin ratio (NAR) has garnered attention as a valuable marker of systemic inflammation in various medical conditions, including inflammatory diseases, vascular disorders, and cancers. [7][8][9][10][11] Combining blood cell counts and serum biochemical indices, NAR has emerged as an informative parameter in clinical research. Studies have demonstrated the utility of NAR as a diagnostic and prognostic marker in different contexts.…”

Clinical Utility of the Neutrophil-to-Bilirubin Ratio in the Detection of Disease Activity in Ulcerative Colitis

“…The inclusion criteria for UC patients were a confirmed diagnosis of UC based on conventional criteria, including clinical signs, endoscopic findings, and histological criteria. 11 Exclusion criteria for UC patients included the presence of other gastrointestinal diseases, cancers, infections, other systemic autoimmune diseases, hypertension, diabetes, hematopoietic system disease, hepatobiliary disease, and coagulation abnormalities. Additionally, to evaluate the potential usefulness of NBR in UC patients, we also retrospectively included 145 non-IBD controls who underwent routine physical examinations in the hospital during the study period.…”

Clinical significance of the C-reactive protein-to-bilirubin ratio in patients with ulcerative colitis

“…UC was diagnosed by clinical findings and radiological examinations, as well as colonoscopic and histopathological confirmation, according to the Consensus on Diagnosis and Treatment of Inflammatory Bowel Disease (2012, Guangzhou) ( 13 ). The exclusion criteria for both UC patients and controls were as follows: smoking, excessive drinking, hematopoietic system disease, hepatobiliary disease, coagulation abnormalities, hypertension, diabetes, infections, other systemic autoimmune diseases, other gastrointestinal diseases, and cancers.…”