Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy

Con, Danny; Andrew, Bridgette; Nicolaides, Steven; Langenberg, Daniel R. van; Vasudevan, Abhinav

doi:10.5217/ir.2020.00146

Cited by 31 publications

(25 citation statements)

References 47 publications

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“…CRP level has been suggested as a predictor of poor outcome in UC patients 27 and considered a biomarker of response to IFX induction therapy. 28,29 Endoscopic finding is also one of the major factors determining the severity and prognosis of UC. In this study, the baseline CRP levels were lower in responders than in nonresponders, though without statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study

et al. 2022

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Background/Aims: This study assessed the efficacy and safety of adalimumab (ADA) and explored predictors of response in Korean patients with ulcerative colitis (UC). Methods: A prospective, observational, multicenter study was conducted over 56 weeks in adult patients with moderately to severely active UC who received ADA. Clinical response, remission, and mucosal healing were assessed using the Mayo score. Results: A total of 146 patients were enrolled from 17 academic hospitals. Clinical response rates were 52.1% and 37.7% and clinical remission rates were 24.0% and 22.0% at weeks 8 and 56, respectively. Mucosal healing rates were 39.0% and 30.1% at weeks 8 and 56, respectively. Prior use of anti-tumor necrosis factor-α (anti-TNF-α) did not affect clinical and endoscopic responses. The ADA drug level was significantly higher in patients with better outcomes at week 8 (P < 0.05). In patients with lower endoscopic activity, higher body mass index, and higher serum albumin levels at baseline, the clinical response rate was higher at week 8. In patients with lower Mayo scores and C-reactive protein levels, clinical responses, and mucosal healing at week 8, the clinical response rate was higher at week 56. Serious adverse drug reactions were identified in 2.8% of patients. Conclusions: ADA is effective and safe for induction and maintenance in Korean patients with UC, regardless of prior anti-TNF-α therapy. The ADA drug level is associated with the efficacy of induction therapy. Patients with better short-term outcomes were predictive of those with an improved long-term response.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study

et al. 2022

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“…Eleven studies employed NLR as a potential tool to predict post-surgical hospital stay or development of various complications in CD [84,[98][99][100][101], UC [93,[102][103][104][105], or IBD [106,107].…”

Section: Nlr To Predict Length Of Post-operative Hospital Stay and Ibd Complicationsmentioning

confidence: 99%

“…In a subset of patients with UC who underwent IPAA, Fleshner et al [105] determined that higher NLR was associated with increased rates of de novo CD as a defined post-surgical complication (p = 0.03). In patients treated with IFX salvage for steroid-refractory acute severe UC, Con et al [103] reported a weak but significant correlation between day 3 NLR and colectomy within twelve months (p = 0.020); NLR value upon admission and on day 1 were not associated with subsequent colectomy (p = 0.340 and 0.792, respectively). Similarly, Andrew et al [93] did not find a correlation between NLR and colectomy after hospital admission prior to or one day following IFX salvage therapy (r = −0.01 and −0.01, respectively; correlation method not specified).…”

Section: Nlr To Predict Length Of Post-operative Hospital Stay and Ibd Complicationsmentioning

confidence: 99%

Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

Langley

Guedry

Goldenberg

et al. 2021

JCM

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Neutrophil–lymphocyte ratio (NLR) is a biomarker of the systemic inflammatory response. The objective of this systematic scoping review was to examine the literature on NLR and inflammatory bowel disease (IBD). PubMed, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, Cochrane Specialized Register, DOAJ, PDQT, Biosis Citation Index, Scopus, and Web of Science were systematically searched. A total of 2621 citations yielding 62 primary studies were synthesized under four categories: distinguishing patients with IBD from controls, disease activity differentiation, clinical outcome prediction, and association of NLR with other IBD biomarkers. Thirty-eight studies employed receiver operating characteristic (ROC) curve analysis to generate optimal NLR cutpoints for applications including disease activity differentiation and prediction of response to treatment. Among the most promising findings, NLR may have utility for clinical and endoscopic disease activity differentiation and prediction of loss of response to infliximab (IFX). Overall findings suggest NLR may be a promising IBD biomarker. Assessment of NLR is non-invasive, low cost, and widely accessible given NLR is easily calculated from blood count data routinely and serially monitored in patients with IBD. Further research is justified to elucidate how evaluation of NLR in research and clinical practice would directly impact the quality and cost of care for patients living with IBD.

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“…In an Irish study of 124 patients with acute severe UC, CAR was significantly higher in steroid-refractory patients than in steroid-responsive patients [ 15 ]. In an Australian retrospective study of steroid-refractory UC patients, CAR was positively associated with colectomy after infliximab [ 16 ]. Taking these results together, CAR is positively associated with clinical activity, endoscopic activity, and poor response to medication in UC patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some studies have reported an association between the C-reactive protein (CRP)-to-albumin ratio (CAR), a useful serum marker for several other diseases [ 8 – 12 ], and UC [ 13 – 16 ]. Evidence regarding the association between CAR and clinical outcomes in UC remains scarce, however.…”

Section: Introductionmentioning

confidence: 99%

Effect of disease duration on the association between C-reactive protein-albumin ratio and endoscopic activity in ulcerative colitis

et al. 2022

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Background A simple serum biomarker for clinical outcome in patients with ulcerative colitis (UC) remains an unmet need. Some studies have shown an association between C-reactive protein (CRP)-albumin ratio (CAR) and prognosis in patients with inflammatory bowel disease (IBD), but evidence regarding the association between CAR and UC remains limited. We evaluated the association between CAR and clinical outcome in Japanese patients with UC. Methods Subjects were 273 Japanese patients with UC. Clinical remission was defined as absence of both abnormally high stool frequency (< 3 per day) and rectal bleeding. Mucosal healing (MH) was defined as Mayo endoscopic subscore (MES) 0. Moderate to severe endoscopic activity was defined as MES 2–3. Subjects were divided according to CAR into tertiles (low, moderate, and high). Results The proportions of patients with clinical remission, MH, and moderate to severe endoscopic activity were 57.9%, 26.0%, and 37.0%, respectively. High CAR was significantly positively associated with moderate to severe endoscopic activity but not MH or clinical remission after adjustment (adjusted odds ratio [OR] 2.18 [95% confidence interval (CI) (1.11–4.35)], p for trend 0.023), but only in patients with long disease duration (> 7 years) (adjusted OR 2.95 [95% CI (1.06–8.79)], p for trend 0.023). CAR was not associated with clinical remission or MH. Conclusions CAR may be significantly positively associated with moderate to severe endoscopic activity but not clinical remission or MH in Japanese patients with UC. In patients with long UC duration, CAR might be a useful serum marker for disease activity.

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Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy

Cited by 31 publications

References 47 publications

Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study

Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study

Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

Effect of disease duration on the association between C-reactive protein-albumin ratio and endoscopic activity in ulcerative colitis

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