Background
Current biomarkers in ulcerative colitis (UC) are limited by their performance, cost and limited availability in daily practice. This study examined alterations in the leukocyte profiles as biomarkers of UC activity including the effects of age, gender and medications.
Methods
Case control study that included 110 UC subjects, 75 subjects with C. difficile infection, and 75 non-inflammatory bowel disease (IBD) subjects, randomly selected from a single institution IBD database. Mean values of neutrophils (N), lymphocytes (L), monocytes (M) and their ratios were compared between groups. ROC curve analyses assessed the performance of each biomarker in discriminating disease states. Subgroup analyses examined leukocytes profiles with endoscopic activity.
Results
Elevated monocyte counts and decreased L/M values significantly differed between subjects with active UC and UC in remission and performed better than other leukocyte profiles. A monocyte count of 483 and L/M ratio of 3.1 were 60% sensitive and had a specificity of 61% and 53% respectively for active UC. Monocyte count > 860 and L/M value < 1.6 had a 75% positive predictive value for UC activity. Those markers also correlated with endoscopically active disease. L/M and N/L values performed best at differentiating active UC from non-IBD controls, while N/L and neutrophil values performed best at differentiating from C. diff controls.
Conclusion
Monocytosis and a low L/M ratio might be effective, readily available and low cost biomarkers to identify disease activity in UC patients. N/L values were more effective at distinguishing active UC patients from patients without IBD and those with C. diff infection.