C-reactive protein/abumin ratio is a useful biomarker for predicting the mucosal healing in the Crohn disease

Zhou, Fusheng; Gao, Nan; Sun, Xiaofen; Jiang, Xiaoyun; Chen, Jiajie; Mao, Qinan; Liu, Zhong

doi:10.1097/md.0000000000024925

Cited by 16 publications

(22 citation statements)

References 35 publications

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“…Twenty-four studies compared NLR values in patients with CD [ 35 , 36 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ], UC [ 35 , 36 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ], or IBD to NLR values in non-IBD controls [ 69 , 70 , 71 ].…”

Section: Resultsmentioning

confidence: 99%

“…CD: Zhou et al [ 50 ] determined an NLR cutpoint at 4.45 could predict mucosal healing (defined as SES-CD 0-2; 83.9% sensitivity, 46.9% specificity).…”

Section: Resultsmentioning

confidence: 99%

Section: Nlr Differences In Ibd Vs Non-ibdmentioning

confidence: 99%

“…Twenty-four studies compared NLR values in patients with CD [35,36,[50][51][52][53][54][55][56], UC [35,36,[56][57][58][59][60][61][62][63][64][65][66][67][68], or IBD to NLR values in non-IBD controls [69][70][71]. [55], and Zhou et al [50] reported significantly higher NLR values in patients with CD than in healthy controls (p < 0.05, =0.034, <0.01, <0.001, and <0.001, respectively). Zhang et al (2017) [56] and Acarturk et al [35] reported significant differences in NLR between patients with active CD compared to healthy controls (p < 0.005 and <0.001, respectively), but not between patients with inactive disease compared to controls (both p > 0.05).…”

Section: Nlr Differences In Ibd Vs Non-ibdmentioning

confidence: 99%

“…Simple Endoscopic Score for Crohn's Disease (SES-CD): Zhou et al [50] reported that NLR correlated with mucosal healing (SES-CD ≤ 2; r s = −0.31, p < 0.001). However, using multivariate regression analysis, Crispino et al [83] reported that no association was found between NLR and SES-CD prior to starting biologics (p = 0.859).…”

Section: Relationship Between Nlr and Endoscopic Disease Activitymentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

“…CD: Zhou et al [ 50 ] determined an NLR cutpoint at 4.45 could predict mucosal healing (defined as SES-CD 0-2; 83.9% sensitivity, 46.9% specificity).…”

Section: Resultsmentioning

confidence: 99%

Section: Nlr Differences In Ibd Vs Non-ibdmentioning

confidence: 99%

Section: Nlr Differences In Ibd Vs Non-ibdmentioning

confidence: 99%

Section: Relationship Between Nlr and Endoscopic Disease Activitymentioning

confidence: 99%

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

Langley

Guedry

Goldenberg

et al. 2021

JCM

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Clinical utility of C‐reactive protein‐to‐albumin ratio in the management of patients with inflammatory bowel disease

Nguyen,

Brick,

Liu

et al. 2024

JGH Open

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Background and AimC‐reactive protein (CRP)‐to‐albumin ratio (CAR) is a novel score with prognostic value in inflammatory conditions. This study assessed the performance of CAR as an objective marker of disease activity and prediction of subtherapeutic infliximab trough levels in patients with inflammatory bowel disease (IBD).MethodsA retrospective study was conducted on three different patient cohorts with IBD: patients who had (i) fecal calprotectin (FC) measurements; (ii) Mayo Endoscopic Scores; and (iii) infliximab trough levels available. The relative performances of CAR, albumin, and CRP were compared in predicting disease activity (based on FC or Mayo Endoscopic Score) and infliximab trough levels.ResultsIn both the FC (n = 289) and endoscopy (n = 65) cohorts, albumin and CAR correlated with objective disease activity. CAR (area under the curve [AUC] 0.70) was only marginally better at detecting active disease, measured by FC, compared to CRP (AUC 0.68). A CAR >0.15 was able to detect Mayo 3 disease (AUC 0.83, sensitivity 81%, specificity 89%). Albumin (r = 0.38) and CAR (r = −0.42) correlated with infliximab trough levels (n = 204). The optimal CAR for detecting subtherapeutic infliximab trough levels was >0.08 (AUC 0.70, sensitivity 66%, specificity 64%). Both albumin and CAR were independent predictors of subtherapeutic infliximab trough levels but correlated poorly with infliximab trough levels longitudinally in the same patient.ConclusionCAR was only a modest discriminator of subtherapeutic infliximab levels and offers little more than CRP in detecting active disease. CAR has potential to detect severe Mayo 3 disease and could be calculated in patients admitted with suspected acute severe ulcerative colitis.

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Altered Bioavailability and Pharmacokinetics in Crohn’s Disease: Capturing Systems Parameters for PBPK to Assist with Predicting the Fate of Orally Administered Drugs

Alrubia

Mao²,

Chen³

et al. 2022

Clin Pharmacokinet

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Backgrond and Objective Crohn’s disease (CD) is a chronic inflammatory bowel disease that affects a wide age range. Hence, CD patients receive a variety of drugs over their life beyond those used for CD itself. The changes to the integrity of the intestine and its drug metabolising enzymes and transporters (DMETs) can alter the oral bioavailability of drugs. However, there are other changes in systems parameters determining the fate of drugs in CD, and understanding these is essential for dose adjustment in patients with CD. Methods The current analysis gathered all the available clinical data on the kinetics of drugs in CD (by March 2021), focusing on orally administered small molecule drugs. A meta-analysis of the systems parameters affecting oral drug pharmacokinetics was conducted. The systems information gathered on intestine, liver and blood proteins and other physiological parameters was incorporated into a physiologically based pharmacokinetic (PBPK) platform to create a virtual population of CD patients, with a view for guiding dose adjustment in the absence of clinical data in CD. Results There were no uniform trends in the reported changes in reported oral bioavailability. The nature of the drug as well as the formulation affected the direction and magnitude of variation in kinetics in CD patients relative to healthy volunteers. Even for the same drug, the reported changes in exposure varied, possibly due to a lack of distinction between the activity states of CD. The highest alteration was seen with S -verapamil and midazolam, 8.7- and 5.3-fold greater exposure, respectively, in active CD patients relative to healthy volunteers. Only one report was available on liver DMETs in CD, and indicated reduced CYP3A4 activity. In a number of reports, mRNA expression of DMETs in the ileum and colon of CD patients was measured, focussing on P-glycoprotein (p-gp) transporter and CYP3A4 enzyme, and showed contradictory results. No data were available on protein expression in duodenum and jejunum despite their dominant role in oral drug absorption. Conclusion There are currently inadequate dedicated clinical or quantitative proteomic studies in CD to enable predictive PBPK models with high confidence and adequate verification. The PBPK models for CD with the available systems parameters were able to capture the major physiological influencers and the gaps to be filled by future research. Quantification of DMETs in the intestine and the liver in CD is warranted, alongside well-defined clinical drug disposition studies with a number of index drugs as biomarkers of changes in DMETs in these patients, to avoid large-scale dedicated studies for every drug to determine the effects of disease on the drug’s metabolism and disposition and the consequential safety and therapeutic concerns. Supplementary Information The online version contains supplementary material av...

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C-reactive protein/abumin ratio is a useful biomarker for predicting the mucosal healing in the Crohn disease

Cited by 16 publications

References 35 publications

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

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

Clinical utility of C‐reactive protein‐to‐albumin ratio in the management of patients with inflammatory bowel disease

Altered Bioavailability and Pharmacokinetics in Crohn’s Disease: Capturing Systems Parameters for PBPK to Assist with Predicting the Fate of Orally Administered Drugs

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