血清学指标在评估炎症性肠病活动度中的应用

炎症性肠病(inflammatory bowel disease，IBD)是以胃肠道慢性炎症为特征的疾病，主要包括两种亚型，即克罗恩病(Crohn’s disease，CD)和溃疡性结肠炎(ulcerative colitis，UC)。内镜检查结合活检是用于IBD诊断和疾病管理最有效的方法，但其昂贵且具有侵入性，有肠穿孔和出血的风险。近年来研究人员在不断探索可替代的、非侵入性生物标志物作为监测IBD活动性和疾病管理的工具。血清学检测是一种成熟的诊断各种免疫性疾病的工具，其在IBD中的应用主要集中在确诊的患者身上，很少有人研究其作为疑似IBD患者主要诊断工具的潜力。本文介绍目前在IBD实验室检测中具有重要临床意义的非侵入性血清学标志物，这些血清学标志物可用于辅助诊断IBD并监测疾病的活动性，有助于临床医生精准把控疾病进展并及时调整治疗方案。

目的 探究血清铜/锌、血乳酸（LA）/白蛋白（ALB）比值（LAR）联合粪便钙卫蛋白（FC）对溃疡性结肠炎（UC）病情及治疗结局的评估价值。 方法 选取154例活动期UC患者并依据病情分为轻度活动组45例、中度活动组61例与重度活动组48例；另根据治疗结局分为好转组106例与未好转组48例。比较不同组血清铜/锌比值、LAR、FC等实验室指标水平，分析指标与UC患者病情及治疗结局的关系。 结果 轻度活动组、中度活动组、重度活动组的血清铜/锌比值、LAR、FC水平依次升高（ P <0.05）；与轻度活动组比较，重度活动组血清前白蛋白（PAB）水平低（ P <0.05）；与好转组比较，未好转组血清铜/锌比值、LAR、FC水平高（ P <0.05）；Spearman相关性分析显示，UC患者血清铜/锌比值、LAR、FC水平与UC内镜下严重程度指数（UCEIS）评分呈正相关（ P <0.05）；多因素Logistic回归分析显示，血清铜/锌比值、LAR、FC水平升高为UC病情加重及治疗结局未好转的危险因素（ P <0.05）；受试者工作特征（ROC）曲线分析显示，血清铜/锌比值、LAR、FC联合评估UC病情加重及治疗结局未好转的曲线下面积（AUC）分别为0.949（95% CI ：0.902~0.978）、0.936（95% CI ：0.885~0.969）。 结论 血清铜/锌比值、LAR、FC可作为预测病情及治疗结局的可靠生物标志物，且指标联合预测效能更佳。

目的 探讨炎症性肠病（IBD）患儿血清前梯度同源蛋白2（AGR2）、氧化三甲胺（TMAO）水平与肠道菌群的关系。 方法 选取145例IBD患儿为观察组，根据疾病类型分为溃疡性结肠炎组64例和克罗恩病组81例，同时纳入于本院进行健康体检的儿童140例作为对照组。采用酶联免疫吸附试验（ELISA）检测血清AGR2、TMAO水平。分别采用改良梅奥（Mayo）评分和克罗恩病活动指数（CDAI）评分评估溃疡性结肠炎和克罗恩病的疾病活动度，根据疾病活动度分为活动期组（75例）和缓解期组（70例）。采集患儿粪便样本进行肠道菌群培养鉴定和计数。绘制受试者工作特征（ROC）曲线分析血清AGR2、TMAO水平对溃疡性结肠炎和克罗恩病的诊断价值。Pearson检验分析血清AGR2、TMAO水平与肠道菌群的相关性。Logistic回归分析血清AGR2、TMAO水平与IBD患儿疾病分期的关系。 结果 溃疡性结肠炎组、克罗恩病组血清AGR2水平低于对照组，TMAO水平高于对照组（ P <0.05）。血清AGR2、TMAO水平单独和联合诊断溃疡性结肠炎的曲线下面积（AUC）为0.835、0.836、0.896，诊断克罗恩病的AUC为0.859、0.864、0.964。活动期组血清AGR2水平及乳酸杆菌、双歧杆菌数量低于缓解期组，血清TMAO水平及大肠杆菌、肠球菌、幽门螺杆菌、链球菌数量高于缓解期组（ P <0.05）。IBD患儿血清AGR2水平与乳酸杆菌、双歧杆菌数量呈正相关，与大肠杆菌、肠球菌、幽门螺杆菌、链球菌数量呈负相关（ P <0.05）；血清TMAO水平与乳酸杆菌、双歧杆菌数量呈负相关，与大肠杆菌、肠球菌、幽门螺杆菌、链球菌数量呈正相关（ P <0.05）。血清AGR2水平降低、TMAO水平升高是IBD患儿疾病进展为活动期的危险因素（ P <0.05）。 结论 血清AGR2、TMAO联合可有效诊断溃疡性结肠炎和克罗恩病，且对克罗恩病诊断价值更高，二者表达异常可能通过影响肠道菌群结构变化参与IBD疾病进展。

目的 探讨中性粒细胞-血小板压积比值(NPR)、粪便钙卫蛋白(FC)、D-二聚体(D-D)、中性粒细胞-淋巴细胞比值(NLR)在判断CD患者疾病活动程度的效用。 方法 回顾性分析2019年4月—2023年4月在广州中医药大学第二附属医院收治的63例CD患者。根据蒙特利尔分型、克罗恩病活动指数(CDAI)进行分组，比较各组间FC、D-D、NLR、NPR水平的差异，绘制试者操作特征(ROC)曲线，计算ROC曲线下面积(AUC)，评价各指标判断CD活动期、中重度活动期的价值。 结果 缓解期、轻度活动期、中重度活动期CD患者的FC、D-D、NLR、NPR水平比较差异有统计学意义( P ＜0.05)。CD患者蒙特利尔分型L1(仅累及回肠)与L3(累及回肠和结直肠)之间的FC水平差异有统计学意义( P ＜0.05)，而D-D、NLR、NPR的水平在不同疾病部位、疾病行为间差异无统计学意义(均 P >0.05)。FC、D-D、NLR、NPR水平与CD疾病活动程度呈正相关(均 P ＜0.05)。FC在判断活动期CD患者的效用最佳，AUC为0.765(95% CI ：0.644~0.887)，灵敏度为60.0%，特异度为91.4%。FC、D-D、NLR、NPR判断CD中重度活动期的AUC均>0.7(均 P ＜0.05)。其中，NPR的效用最佳，AUC为0.795(95% CI ：0.682~0.908)，灵敏度为70.0%，特异度为84.8%。 结论 FC能有效判断CD疾病活动程度。NPR在判断中重度活动期CD患者的效用优于FC，在CD的疾病评估与监测中具有一定潜力。

目的 :比较炎症标志物C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、降钙素原(PCT)对溃疡性结肠炎(UC)临床应用价值。 方法 :回顾性分析UC患者74例(UC组)和健康体检人群32例(对照组),收集UC患者CRP、SAA、PCT、肠道内镜检测结果、Mayo评分,通过ROC曲线分析CRP、SAA、PCT对UC价值并确定最佳截断值,根据截断值将炎症指标分层,通过单因素分析、二元Logistic回归分析确定炎症指标是否为UC影响因素,相关性分析评价炎症指标与Baron内镜分级、Mayo评分的关系,并对比不同疾病严重程度UC患者炎症指标的差异。 结果 :CRP、SAA、PCT对UC的ROC曲线下面积(AUC)分别为0.711、0.813、0.636,最佳截断值分别为12.58 mg/L、16.21 mg/L、0.71 ng/mL,AUC SAA >AUC CRP 、AUC PCT ,(均 P <0.05),CRP、PCT均UC的影响因素(均 P <0.05),PCT不是UC的影响因素( P >0.05),CRP、SAA、PCT与Baron内镜分级相关系数( r )分别为0.458、0.513、0.329,均 P <0.05, r SAA > r CRP > r PCT ,SAA、CRP阳性率在Baron内镜分级的上升趋势有统计学意义(均 P <0.05),CRP、SAA、PCT与UC患者Mayo评分 r 值分别为0.384、0.417、0.251,均 P <0.05, r SAA > r CRP > r PCT ,UC缓解期CRP、PCT、SAA低于活动期,轻度活动期、中度活动期、重度活动期CRP、SAA差异均有统计学意义(均 P <0.05)。 结论 :CRP、SAA、PCT对UC有一定临床价值,SAA反映UC肠道黏膜愈合、疾病严重程度和活动性价值均优于CRP、PCT。

目的: 比较炎症指标C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、降钙素原(PCT)对克罗恩病(CD)患者的临床诊断、内镜活动性、临床活动性预测价值。 方法: 回顾性分析CD患者76例(CD组)和健康体检人群36例(对照组),收集所有CD患者CRP、SAA、PCT、CD简化内镜评分(SES-CD)、CD活动指数(CDAI)等检测结果,比较对照组、CD组炎症指标结果差异,通过受试者工作曲线(ROC)确定不同炎症指标对CD诊断、内镜下活动性、临床活动性预测价值,分析不同炎症指标与SES-CD、CDAI相关性,比较不同临床严重程度的CD患者炎症指标的差异。 结果: CD组炎症指标均高于对照组,差异有统计学意义( P r )值分别为0.442、0.676、0.314,与CDAI r 值分别为0.459、0.621、0.289( P 结论: CRP、SAA、PCT对CD诊断均有较好预测价值,CRP、SAA对内镜活动性、临床活动性预测价值较高,预测价值SAA>CRP>PCT。

[目的] 观察活动期溃疡性结肠炎（UC）患者血脂与蛋白质水平，评价其与病情严重程度间的关系。 [方法] 对活动期UC住院患者94例与体检正常者（对照组）100例的总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）水平进行回顾并研究其与严重程度之间的关系。 [结果] 与对照组比较，活动期UC患者TC、TG、LDL、HDL、TP、ALB、PA水平明显降低，TC、TP、ALB水平与Baron评分呈负相关，ALB与ESR负相关。 [结论] 活动期UC患者易出现血脂及蛋白异常，TC、ALB可作为病情严重程度评价指标。

目的 探讨C反应蛋白/白蛋白比值(CRP/ALB)、炎症标志物和全血计数水平与炎症性肠病(IBD)活动性的相关性。 方法 将2015年1月—2020年12月诊治的584例IBD患者纳入研究，其中溃疡性结肠炎(UC)183例，克罗恩病(CD)401例，分析血清CRP、ALB、血沉(ESR)和全血计数与IBD的关系，采用Mayo评分和Crohn疾病活动指数分别评估UC和CD患者的疾病活动性。 结果 活动期IBD患者的CRP/ALB比值、CRP、ESR、血小板/淋巴细胞比值(PLR)、红细胞分布宽度、中性粒细胞/淋巴细胞比值(NLR)明显高于缓解期，而ALB和淋巴细胞/单核细胞比值(LMR)明显低于缓解期( P < 0.05)。受试者工作特征曲线分析结果显示，活动期UC和CD的CRP/ALB比值的最佳截断值分别为0.17和0.42，敏感性分别为67.9%和75.7%，特异性分别为86.5%和92.1%。多因素logistic回归分析显示，在调整炎症标志物(ESR、NLR、PLR和LMR)后，CRP/ALB比值在区分UC和CD疾病活动性上差异有统计学意义( P < 0.001)。 结论 CRP/ALB比值水平与IBD疾病活动性密切相关，可用于UC和CD疾病活动性的评估。

摘要: 目的： 评估预后营养指数（PNI）与客家人炎症性肠病（IBD）住院患者疾病严重程度及反复发作的关系，以早期判定疾病的程度、确定治疗方案及评估疾病的预后。 方法： 回顾性分析2019-2020年于梅州市人民医院住院的271例客家人IBD患者的一般情况、临床表现、肠镜检查结果、炎症严重程度、治疗药物、住院次数、血液学指标如PNI、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR），以克罗恩病活动指数、Mayo评分将患者分为轻度、中重度，根据住院次数将患者分为首次住院与反复发作住院，对以上数据进行统计分析。 结果： 271例患者中119例为克罗恩病（CD），152例为溃疡性结肠炎（UC），一般情况显示反复发作者病程较首次住院者的中位数病程更长，差异有统计学意义（ P 结论： NLR、PLR、PNI预测客家人IBD严重程度、PNI预测IBD反复发作有临床参考价值。

Serological biomarkers in inflammatory bowel disease (IBD) are a rapidly expanding list of non-invasive tests for objective assessments of disease activity, early diagnosis, prognosis evaluation and surveillance. This review summarizes both old and new biomarkers in IBD, but focuses on the development and characterization of new serological biomarkers (identified since 2007). These include five new anti-glycan antibodies, anti-chitobioside IgA (ACCA), anti-laminaribioside IgG (ALCA), anti-manobioside IgG (AMCA), and antibodies against chemically synthesized (Sigma) two major oligomannose epitopes, Man alpha-1,3 Man alpha-1,2 Man (SigmaMan3) and Man alpha-1,3 Man alpha-1,2 Man alpha-1,2 Man (SigmaMan4). These new biomarkers serve as valuable complementary tools to existing biomarkers not only in differentiating Crohn's disease (CD), ulcerative colitis (UC), normal and other non-IBD gut diseases, but also in predicting disease involvement (ileum vs colon), IBD risk (as subclinical biomarkers), and disease course (risk of complication and surgery). Interestingly, the prevalence of the antiglycan antibodies, including anti-Saccharomyces cerevisiae antibodies (ASCA), ALCA and AMCA, was found to be associated with single nucleotide polymorphisms (SNPs) of IBD susceptible genes such as NOD2/CARD15, NOD1/CARD4, toll-like receptors (TLR) 2 and 4, and beta-defensin-1. Furthermore, a gene dosage effect was observed: anti-glycan positivity became more frequent as the number of NOD2/CARD15 SNPS increased. Other new serum/plasma IBD biomarkers reviewed include ubiquitination factor E4A (UBE4A), CXCL16 (a chemokine), resistin, and apolipoprotein A-IV. This review also discusses the most recent studies in IBD biomarker discovery by the application of new technologies such as proteomics, fourier transform near-infrared spectroscopy, and multiplex enzyme-linked immunosorbent assay (ELISA)'s (with an emphasis on cytokine/chemokine profiling). Finally, the prospects of developing more clinically useful novel diagnostic algorithms by incorporating new technologies in serological biomarker profiling and integrating multiple biomarkers with bioinformatics analysis/modeling are also discussed.

Background Current biomarkers have been routinely used noninvasive methods for assessing disease activity of inflammatory bowel disease (IBD), but none of them are specific. This study was aimed to determine the performance of the serological biomarkers for detecting disease activity in patients with IBD. Methods A prospective study that included 73 ulcerative disease (UC) subjects, 141 Crohn's disease (CD) subjects, and 30 of them complicated with C. difficile infection (CDI) were diagnosed at a single-institution IBD center. Disease activity was assessed using by Truelove and Witts criteria for UC and Harvey Bradshaw Simple Index for CD. Serological inflammatory biomarkers were compared in different severity groups. Receiver operator curve analyses assessed the performance of each biomarker in discriminating disease states. Results For UC patients, elevated monocyte counts, C-reactive protein (CRP), and decreased lymphocyte counts and lymphocyte/monocyte ratio (LMR) significantly differed between subjects with active and inactive UC. LMR of 3.1 was 76% sensitive and had a specificity of 67% for active UC. For CD patients, higher values of neutrophils, monocytes, neutrophil/lymphocyte ratio, CRP, fibrinogen, and lower values of LMR and hemoglobin were significantly different between subjects with active and inactive CD. None of the biomarkers included had a good correlation with disease activity (area under the ROC Curve < 0.70). Conclusions A low LMR represents an inexpensive, readily available test with a promising value to identify disease activity in UC patients, whereas none of the inflammatory biomarkers showed a discriminative value in disease activity of CD.

Background: Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a chronic, inflammatory disorder of the gastrointestinal tract. As the novel therapeutic goal and biologicals are widely recognized, accurate assessment of disease and prediction of therapeutic response have become a crucial challenge in clinical practice. Also, because of the continuously rising incidence, convenient and economical methods of diagnosis and clinical assessment are urgently needed. Recently, serum biomarkers have made a great progress and become a focus in IBD study because they are non-invasive, convenient, and relatively inexpensive than are markers in biopsy tissue, stool, breath, and other body fluids. Aims: To review the available data on serological biomarkers for IBD. Methods: We searched PubMed using predefined key words on relevant literatures of serum biomarkers regarding diagnosis, evaluation of therapeutic efficacy, surveillance of disease activity, and assessment of prognosis for IBD. Results: We reviewed serological biomarkers that are well-established and widely used (e.g., C-reactive protein), newly discovered biomarkers (e.g., cytokines, antibodies, and non-coding RNAs), and also recently advancements in serological biomarkers (e.g., metabolomics and proteomics) that are used in different aspects of IBD management. Conclusions: With such a wealth of researches, to date, there are still no ideal serum biomarkers for IBD. Serum profiling and non-coding RNAs are just starting to blossom but reveal great promise for future clinical practice. Combining different biomarkers can be valuable in improving performance of disease evaluation.

… Serological biomarkers, including CRP, have low accuracy to detect endoscopic activity in ulcerative colitis and postoperative Crohn's disease. … endoscopic activity in Crohn's disease. …

… A number of promising serologic and fecal biomarkers have emerged that could fulfill this role, including C-reactive protein (CRP), interleukin 6 (IL-6), lactoferrin (Lf), and calprotectin (Cp…

Inflammatory bowel disease (IBD) is a heterogeneous group of chronic inflammatory disorders of the gastrointestinal tract with two main distinguishable entities, Crohn’s disease (CD) and ulcerative colitis (UC). IBD-unclassified (IBD-U) is a diagnosis that covers the “grey” zone of diagnostic uncertainty between UC and CD. Current diagnosis of IBD relies on the clinical, endoscopic, radiological, histological and biochemical features, but this approach has shortcomings especially in cases of overlapping symptoms of CD and UC. The need for a diagnostic tool that would improve the conventional methods in IBD diagnosis directed the search towards potential immunological markers, since an aberrant immune response against microbial or endogenous antigens in a genetically susceptible host seems to be implicated in IBD pathogenesis. The spectrum of antibodies to different microbial antigens and autoantibodies associated with IBD is rapidly expanding. Most of these antibodies are associated with CD like anti-glycan antibodies: anti-Saccharomices cerevisiae (ASCA) and the recently described anti-laminaribioside (ALCA), anti-chitobioside (ACCA), anti-mannobioside (AMCA), anti-laminarin (anti-L) and anti-chitin (anti-C) antibodies; in addition to other antibodies that target microbial antigens: anti-outer membrane porin C (anti-OmpC), anti-Cbir1 flagellin and anti-I2 antibody. Also, autoantibodies targeting the exocrine pancreas (PAB) were shown to be highly specific for CD. In contrast, UC has been associated with anti-neutrophil cytoplasmic autoantibodies (pANCA) and antibodies against goblet cells (GAB). Current evidence suggests that serologic panels of multiple antibodies are useful in differential diagnosis of CD versus UC and can be a valuable aid in stratifying patients according to disease phenotype and risk of complications.

… This study will focus on the utility of biomarkers in measuring disease activity and predicting … of disease activity and to predict relapse in patients with IBD. These include serological …

Inflammatory bowel disease (IBD) is an enduring disease involving mostly young people, with symptoms of bloody diarrhea and abdominal cramps. Several antibodies have been associated with IBD, the 2 most comprehensively studied being autoantibodies to neutrophils (atypical perinuclear anti-neutrophil cytoplasmic antibodies) and anti-Saccharomyces cerevisiae antibodies. This review focuses on the value of these antibodies for diagnosing IBD, differentiating Crohn disease from ulcerative colitis, indeterminate colitis, monitoring disease, defining clinical phenotypes, predicting response to therapy, and as subclinical markers. Pancreatic antibodies and newly identified anti-microbial antibodies (anti-outer membrane porin C, anti-I2, and anti-flagellin) are also reviewed.

Background The aim was to study the association between six serological markers and Crohn’s disease (CD) activity at an inflammatory bowel disease (IBD) referral center. Methods We designed a retrospective cohort study using adults (> 18 years) with CD followed for at least 1 year at University of Alabama at Birmingham. Baseline serological markers ASCA-IgA, ASCA-IgG, anti-OmpC IgA, anti-CBir1 IgG, anti-A4Fla2 IgG and anti-FlaX IgG were drawn at initial visit. Poisson regression was used to assess the longitudinal relationship between these markers drawn at baseline and rate of active clinical disease during follow-up. Results Each marker, from 135 patients, was categorized into high vs. low. A Poisson regression model adjusted for age, gender, race, duration of disease, obesity, proton pump inhibitor; steroid and thiopurine use, and disease location demonstrated that CD patients with high anti-CBir1 IgG at baseline were approximately twice more likely to have active clinical disease (incidence rate ratio (IRR) 2.06, 95% confidence interval (CI) 1.28 - 3.33, P = 0.0032). The unadjusted Poisson regression model for A4Fla2 IgG antibody level did suggest that a high A4Fla2 IgG at baseline was associated with a higher likelihood of active CD (IRR 1.64, 95% CI 1.07, 2.53, P = 0.0238) which however, upon adjustment based on effect size, was not significant. The other four antibodies did not appear to predict clinical course. Conclusions High levels of anti-CBir1 IgG appear to be associated with a greater likelihood of active CD. Whether routine baseline testing for anti-CBir1 IgG to predict a more active clinical course is warranted needs more research.

Crohn’s disease and ulcerative colitis represent the two main forms of the idiopathic chronic inflammatory bowel diseases (IBD). Currently available blood and stool based biomarkers provide reproducible, quantitative tools which can complement clinical assessment to aid clinicians in IBD diagnosis and management. C-reactive protein and fecal based leukocyte markers can help the clinician distinguish IBD from non-inflammatory diarrhea and assess disease activity. The ability to differentiate between forms of IBD and predict risk for disease complications is specific to serologic tests including antibodies against Saccharomyces cerevisiae and perinuclear antineutrophil cytoplasmic proteins. Advances in genomic, proteomic and metabolomic array based technologies are facilitating the development of new biomarkers for IBD. The discovery of novel biomarkers which can correlate with mucosal healing or predict long term disease course has the potential to significantly improve patient care. This article reviews the uses and limitations of currently available biomarkers and highlights recent advances in IBD biomarker discovery.

Inflammatory bowel disease (IBD) is a common gastrointestinal tract disease and can be divided into two major groups: ulcerative colitis (UC) and Crohn's disease (CD). These two entities can be diagnosed from a combination of invasive and non-invasive tests as well as a thorough history and physical examination. However, invasive tests are preferred for a definitive diagnosis since the two entities have characteristic features of colonoscopy and biopsy. In this review, the following will be discussed: how non-invasive tests could help detect the presence of IBD, how markers help monitor disease progression, and how the disease responds to treatment. Some of the common markers that are discussed in detail include perinuclear antineutrophil cytoplasmatic antibodies (p-ANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), calprotectin, lactoferrin, lipocalin-2 (LCN2), and several other novel markers that are based on bacterial antigens. The best non-invasive tests available for detecting the presence of IBD are serological and fecal markers. Detecting these markers has helped doctors significantly by bringing to their attention the possibility of the presence of IBD. The serological testing can also help distinguish the two forms of IBD since a different combination of markers is elevated in UC and CD. In addition, the symptoms of IBD are non-specific and usually overlap with other gastrointestinal tract disorders, so by finding these serological markers, doctors can proceed with further invasive testing that would give them a definitive diagnosis. That way, invasive testing, such as colonoscopy with biopsy, can be avoided in patients with no suspicion of IBD. The common markers used in the clinical setting to point out the presence of IBD are discussed in detail in this review. Recently, more specific markers derived from bacterial antigens are also used, and their role is discussed, too.

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.

Inflammatory bowel diseases (IBD) are chronic intestinal conditions of multifactorial aetiology including genetic susceptibility, immunological impairment, dysbiosis, and environmental factors. The diagnosis is based on both clinical and endoscopic features, wherein histopathological evaluation remains a gold diagnostic standard. However, fast, reliable, and non-invasive biological markers have been used for years for diagnosis as well as for disease activity monitoring. Currently, commonly used faecal calprotectin is the only biomarker approved and recommended by the European Crohn’s and Colitis Organization (ECCO). Nonetheless, other biological markers discriminating between functional and organic bowel conditions have been widely studied. Therefore, the aim of this manuscript was to review new potential biomarkers of inflammation in IBD. The aim of this study was to review currently available biomarkers of intestinal inflammation and increased gut permeability in IBD.

… serological antibodies, neither as marker for disease activity during follow-up, nor as predictive biomarker at diagnosis for disease … a panel of candidate serological antibodies in newly …

Inflammatory bowel disease (IBD) is characterized as chronic inflammation in the gastrointestinal tract, which includes two main subtypes, Crohn's disease and ulcerative colitis. Endoscopy combined with biopsy is the most effective way to establish IBD diagnosis and disease management. Imaging techniques have also been developed to monitor IBD. Although effective, the methods are expensive and invasive, which leads to pain and discomfort. Alternative noninvasive biomarkers are being explored as tools for IBD prognosis and disease management. This review focuses on novel biomarkers that have emerged in recent years. These serological biomarkers and microRNAs could potentially be used for disease management in IBD, thereby decreasing patient discomfort and morbidity.

Fecal and serologic biomarkers can be used in the diagnosis and management of inflammatory bowel disease (IBD). Fecal markers such as calprotectin and lactoferrin have been studied for their ability to identify patients with IBD, assess disease activity, and predict relapse. Antibodies against Saccharomyces cerevisiae and perinuclear antineutrophil cytoplasmic proteins have been used in diagnosis of IBD, to distinguish Crohn's disease (CD) from ulcerative colitis, and to predict the risk of complications of CD. Tests for c-reactive protein and erythrocyte sedimentation rate have been used to assess inflammatory processes and predict the course of IBD progression. Levels of drug metabolites and antibodies against therapeutic agents might be measured to determine why patients do not respond to therapy and to select alternative treatments. This review addresses the potential for biomarker assays to improve treatment strategies and challenges to their use and development.

… samples and serum albumin were both found to provide objective and representative indicators of endoscopic activity in patients with ulcerative colitis and Crohn’s colitis in this study. …

… genes to be able to distinguish disease activity in Crohn's disease (CD) and ulcerative colitis (UC). … The existing serological markers tend to have low sensitivity and specificity because …

… disease activity in inflammatory bowel disease (IBD), ie., ulcerative colitis (UC) and Crohn’s disease (… It has been reported that serum IL-8 is a poor marker of disease activity in IBD (89). …

Ulcerative colitis (UC) and Crohn's disease (CD) are the major forms of inflammatory bowel diseases (IBD) in man. Despite some common features, these forms can be distinguished by different genetic predisposition, risk factors and clinical, endoscopic and histological characteristics. The aetiology of both CD and UC remains unknown, but several evidences suggest that CD and perhaps UC are due to an excessive immune response directed against normal constituents of the intestinal bacterial flora. Tests sometimes invasive are routine for the diagnosis and care of patients with IBD. Diagnosis of UC is based on clinical symptoms combined with radiological and endoscopic investigations. The employment of non-invasive biomarkers is needed. These biomarkers have the potential to avoid invasive diagnostic tests that may result in discomfort and potential complications. The ability to determine the type, severity, prognosis and response to therapy of UC, using biomarkers has long been a goal of clinical researchers. We describe the biomarkers assessed in UC, with special reference to acute-phase proteins and serologic markers and thereafter, we describe the new biological markers and the biological markers could be developed in the future: (1) serum markers of acute phase response: The laboratory tests most used to measure the acute-phase proteins in clinical practice are the serum concentration of C-reactive protein and the erythrocyte sedimentation rate. Other biomarkers of inflammation in UC include platelet count, leukocyte count, and serum albumin and serum orosomucoid concentrations; (2) serologic markers/antibodies: In the last decades serological and immunologic biomarkers have been studied extensively in immunology and have been used in clinical practice to detect specific pathologies. In UC, the presence of these antibodies can aid as surrogate markers for the aberrant host immune response; and (3) future biomarkers: The development of biomarkers in UC will be very important in the future. The progress of molecular biology tools (microarrays, proteomics and nanotechnology) have revolutionised the field of the biomarker discovery. The advances in bioinformatics coupled with cross-disciplinary collaborations have greatly enhanced our ability to retrieve, characterize and analyse large amounts of data generated by the technological advances. The techniques available for biomarkers development are genomics (single nucleotide polymorphism genotyping, pharmacogenetics and gene expression analyses) and proteomics. In the future, the addition of new serological markers will add significant benefit. Correlating serologic markers with genotypes and clinical phenotypes should enhance our understanding of pathophysiology of UC.

Background: In recent years, various biomarkers of ulcerative colitis (UC) have emerged; however, few studies have simultaneously examined the utility of multiple biomarkers for monitoring disease activity. Additionally, serum leucine-rich alpha-2 glycoprotein (LRG), a new biomarker, may show a blunt response to anti-TNF antibody therapy. This prospective study explored effective biomarkers that could monitor disease activity changes in patients with UC. In addition, we examined the effect of anti-TNF antibody therapy on changes in LRG. Methods: Blood and stool samples were collected twice from patients with UC: at baseline and at least 8 weeks later. Changes in serum LRG, interleukin (IL)-6, prealbumin (pre-Alb), high-sensitivity C-reactive protein (hs-CRP), CRP, and fecal calprotectin (FC) were measured and correlated with changes in disease activity. The relationship between anti-TNF antibody therapy and LRG levels was also examined in patients with the same disease activity. Results: Forty-eight patients with UC (96 samples) were analyzed. ΔLRG and ΔIL-6 correlated strongly with the change in the partial Mayo (pMayo) score between the two time points (ΔpMayo) (r = 0.686, 0.635, respectively). In contrast, FC and IL-6 were particularly accurate predictors of clinical remission, and their area under the curves (AUCs) were significantly higher than that of CRP (AUC: 0.81, 0.76 vs. 0.50; p = 0.001, 0.005). No association was found between the administration of anti-TNF antibody preparations and the LRG values. Conclusions: Correlations were found between changes in UC disease activity and LRG, IL-6, pre-Alb, hs-CRP, CRP, and FC. LRG reflects disease activity during anti-TNF antibody therapy.

The serum concentration of 19 serum proteins was determined by electrophoresis in 42 patients with Crohn's disease and 36 patients with ulcerative colitis. The results were compared with 78 healthy persons as matched controls. Distinctive, but similar, changes were present in the two diseases. An increased serum concentration of orosomucoid, α 1 -antitrypsin, easily precipitable glycoprotein, α 1 -antichymotrypsin, haptoglobin, and haemopexin was present. The serum concentration was decreased for prealbumin, albumin, α 2 -HS glycoprotein, caeruloplasmin, α 2 -macro-globulin, and transferrin. No significant difference between the two diseases existed as far as the serum protein pattern was concerned. Certain proteins, `the acute phase reactants' (orosomucoid, α 1 -antitrypsin, α 1 -antichymotrypsin, and haptoglobin) and the immunoglobulins were clinically useful, since their serum concentration reflected the grade of activity of the disease. A pronounced elevation of haptoglobin compared with that of the other `acute phase reactants' was present in patients with Crohn's disease complicated by suppurative fistulas or abscesses. Patients with active Crohn's disease who responded favourably to medical treatment had significantly higher immunoglobulin levels than patients not responding. A similar observation, though not statistically significant, was made in patients with ulcerative colitis.

… of both Crohn's disease (CD) and ulcerative colitis (UC) has … of clinical markers in inflammatory bowel disease (IBD) has … global disease activity scores (ie the Crohn's Disease Activity …

… activity and various biological inflammatory markers in patients with clinically active CD and normal CRP serum … predictive marker of relapse in ulcerative colitis than in Crohn's disease. …

Extracellular matrix (ECM) homeostasis is highly affected in active inflammatory bowel disease (IBD). The aim of the study was to investigate serological biomarkers of type III, IV, and V collagen degradation and formation, and their association with disease activity in IBD. ECM remodeling serum biomarkers were measured in 162 IBD patients, 110 with Crohn’s disease (CD) and 52 with ulcerative colitis (UC), and in 29 healthy donors. Biomarkers of type III collagen degradation (C3M) and formation (PRO-C3), type IV collagen degradation (C4M) and formation (PRO-C4), and type V collagen formation (PRO-C5) were measured using ELISA. Inflammatory activity was assessed using endoscopic, clinical, and biochemical activity indices. The highest diagnostic value was identified in discriminating endoscopically moderate to severe disease in CD (PRO-C3, C3M/PRO-C3, and C4M with AUC of 0.70, 0.73, and 0.69, respectively) and UC (C3M, C3M/PRO-C3, and C4M with AUC of 0.86, 0.80, and 0.76, respectively). C4M and C3M/PRO-C3 in combination yielded AUC of 0.93 (0.66–0.90) in CD and 0.94 (0.65–0.99) in UC. This study confirmed that ECM remodeling reflected disease activity in CD and UC. A combination of C4M, C3M, and PRO-C3 biomarkers may potentially be considered as a biomarker differentiating moderate to severe endoscopic disease.

… in patients with inflammatory bowel disease and that they are higher and correlate better with clinical assessment of disease activity in Crohn’s than in ulcerative colitis [8]. Serum CRP …

… of CRP, ESR, PUCAI scores, and physician global assessment … of outcomes in 128 children with severe pediatric UC, admitted … CRP was superior in differentiating moderate from severe …

… (40) showed that clinical activity (CDAI) was best predicted-in decreasing order-by orosomucoid, ESR, and CRP. These findings have been confirmed in other studies (64, 65). In …

… , CRP and ESR, and endoscopic disease severity indices. Moreover, we sought to identify the sensitivity and specificity of ESR or CRP … that the Powell-Tuck assessment, which mostly …

Background Endoscopy is currently recognized as the gold standard for assessing inflammatory bowel disease (IBD) severity. However, because the procedure is costly and invasive, endoscopy is not suitable for frequently monitoring intestinal inflammation. In this study, our aim was to identify noninvasive, low cost, and convenient biomarkers for identifying endoscopic IBD activity. Methods In total, 246 patients with IBD (131 with Ulcerative colitis (UC) and 115 with Crohn’s disease (CD)) and 369 healthy controls were recruited for this retrospective study. IBD activity was evaluated using endoscopic and clinical examinations. The potential of several inflammatory biomarkers, including platelets (PLT), plateletcrit (PCT), albumin (ALB), highly sensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and platelet-to-albumin ratio (PLT/ALB) to assess endoscopic IBD activity was evaluated using receiver operating characteristic (ROC) analyses. Results PLT/ALB ratio, PLT, ALB, and hs-CRP levels were correlated with Mayo scores in UC patients, while PCT, PLT, fibrinogen (FIB), PLT/ALB ratio, hs-CRP, and ESR levels were correlated with Simple Endoscopic Scores for CD (SES-CD) in CD patients. ROC analyses showed that the area under the curve (AUC) value for the PLT/ALB ratio (0.705) was greater than hs-CRP (0.607) and ESR (0.552) values in UC patients. The AUC value for PCT (0.779) was greater than hs-CRP (0.698) and ESR (0.746) values in CD patients. Conclusion PLT/ALB ratio and PCT biomarkers were the most appropriate of all tested inflammatory biomarkers for assessing endoscopic IBD activity in UC and CD patients, respectively.

… marker for predicting disease severity, white blood cell count, CRP and ESR are the most … [22], the overall accuracy of white blood cell count and ESR in determining disease activity …

Abstract Background and Aims The erythrocyte sedimentation rate [ESR] as a component of the Truelove and Witts Criteria [TWC] is the traditional inflammatory marker used for the assessment of ulcerative colitis [UC] activity. However, the C-reactive protein [CRP] is preferentially used in contemporary clinical practice. We aimed to determine the equivalent CRP cut-off for an ESR of  >30 mm/h in patients presenting with acute severe UC. Methods Clinical and pathological data were prospectively collected from 163 presentations of severe UC. A CRP cut-off corresponding to an ESR of  >30 mm/h was determined using confusion matrices. A validation cohort of 128 presentations was prospectively collected and analysed. Results A CRP cut-off of ≥12 mg/L generated an 85% positive predictive value [PPV] with a sensitivity of 95% and an accuracy of 82% for having a paired ESR of  >30 mm/h. There were no statistically significant differences between groups determined by the traditional ESR versus the new CRP-based criterion in the presenting faecal calprotectin, Mayo endoscopic subscore, or the rates of intravenous corticosteroid therapy failure and colectomy-by-discharge. Applying the CRP  ≥12 mg/L criterion to a validation cohort of 128 presentations generated a PPV of 83% and a sensitivity of 94%. Conclusions The proposed CRP  ≥12 mg/L cut-off is an inclusive, sensitive, and very practical alternative to ESR as part of the TWC for defining UC presentation severity. It demonstrated similar performance characteristics to the classical ESR criterion when used for the assessment of acute UC disease activity. These findings were confirmed in a validation cohort.

… in 40 patients (58 assessments) with Crohn’s … sedimentation rate [ESR] and C-reactive protein [CRP]) are measures that are used to determine the severity of inflammatory bowel disease…

BACKGROUND/AIMS Direct assessment by endoscopic examination has become a "gold standard" in monitoring patients with ulcerative colitis. However, it is an invasive method, with risks and discomfort for the patients. The aim is therefore to identify a less invasive method of assessing ulcerative colitis activity compared to colonoscopy. MATERIALS AND METHODS A prospective study was conducted among 103 patients with ulcerative colitis. Calprotectin was measured by a semi-quantitative rapid test. For each patient, a complete blood count was performed; liver and kidney functions, glycaemia, serum proteins, and inflammatory markers were also evaluated. RESULTS The Mayo score showed direct correlations with fecal calprotectin, C-reactive protein, and the erythrocyte sedimentation rate (p<0.05) and indirect correlations with hemoglobin (p=0.139). The sensitivity and specificity of calprotectin were 98.0% and 76.7%, respectively. Subsequently, combined analysis of the markers' sensitivity/specificity was conducted. CONCLUSION The semi-quantitative rapid test proved to be a good predictor for differentiating the endoscopic active disease from the inactive one. The individual use of fecal calprotectin presents the highest sensitivity in determining the endoscopic activity. Nevertheless, in monitoring patients, combined determination of the three inflammatory markers studied [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), calprotectin] is more useful in reducing unnecessary colonoscopies.

… the clinical severity and extent of colitis were assessed by the … in therapy for inflammatory bowel disease (IBD), UC remains … as C-reactive protein (CRP), erythrocyte sedimentation rate (…

… count, or erythrocyte sedimentation rate can change during … chronic IBD from IBS, and were correlated with severity of … able to differentiate active IBD from inactive IBD and IBS and …

Objectives The aims of this study were to evaluate the C-reactive protein/albumin ratio (CRP/ALB), inflammatory markers, and parameters from the complete blood count (CBC) in patients with inflammatory bowel disease (IBD) and their associations with disease activity. Methods A total of 876 IBD patients, composed of 275 patients with ulcerative colitis (UC) and 601 patients with Crohn's disease (CD), were included in this retrospective study, and the serum C-reactive protein (CRP), albumin (ALB), erythrocyte sedimentation rate (ESR), and CBC parameters were measured. To explore the disease activity, the Mayo score and Crohn disease activity index were used to assess UC and CD patients, respectively. Results The CRP/ALB ratio, CRP, ESR, platelet to lymphocyte ratio (PLR), red blood cell distribution width (RDW), and neutrophil to lymphocyte ratio (NLR) levels in active IBD patients were significantly higher than those in inactive IBD patients, whereas ALB and lymphocyte to monocyte ratio (LMR) levels were significantly decreased (P < 0.001). The receiver operating characteristic analysis showed that the optimum cut-off values of the CRP/ALB ratio for active UC and CD were 0.18 and 0.43, with sensitivities of 67.8% and 75.8% and specificities of 86.7% and 92.0%, respectively. Multivariable logistic analysis revealed that after adjusting for these inflammatory markers (ESR, NLR, PLR, and LMR), the CRP/ALB ratio was a statistically significant parameter capable of differentiating the disease activity of UC and CD. Conclusions This study indicated that the CRP/ALB ratio was closely related to the IBD disease activity. Compared with CBC parameters, the CRP/ALB ratio had a higher discriminative capacity for active IBD.

Background: Laboratory markers such as white blood cells, C reactive protein, and erythrocyte sedimentation rate can aid in assessing the activity of inflammatory bowel disease but lacks sensitivity and specificity. Fecal calprotectin has higher sensitivity and specificity but it is expensive. Endoscopy is an invasive, inconvenient procedure having complications. No studies are done concerning the neutrophil/lymphocyte ratio in inflammatory bowel disease in pediatrics. The aim of this study was to assess the neutrophil/lymphocyte ratio as a laboratory marker of inflammatory bowel disease activity and severity in children. Methods: This is a prospective study. The study included all patients from 2 months up to 16 years who were confirmed to have inflammatory bowel disease endoscopically and histopathologically. Clinical activity score and Mayo endoscopic subscore were recorded. Laboratory investigations including white blood cells, C reactive protein, erythrocyte sedimentation rate, and fecal calprotectin were done on all patients. The neutrophil/lymphocyte ratio was calculated and correlated with different activity markers. Results: We included 50 inflammatory bowel disease patients. The mean neutrophil/lymphocyte ratio in ulcerative colitis was 1.76 ± 0.36, Crohn’s disease was 1.50 ± 0.41, and it was 1.47 ± 0.14 in indeterminate colitis. Neutrophil/lymphocyte ratio was significantly correlated to erythrocyte sedimentation rate, C reactive protein, fecal calprotectin, clinical activity score, and Mayo endoscopic subscore. Conclusion: Neutrophil/lymphocyte ratio can be used as an activity and severity marker in children with inflammatory bowel disease.

BACKGROUND AND STUDY AIMS Monitoring disease activity in ulcerative colitis (UC) is critical in preventing long-term complications. This study aims to develop a scoring system using non-invasive indicators to predict endoscopic activities for ulcerative colitis (UC) patients. PATIENTS AND METHODS All enrolled patients with UC admitted to Shanghai Xinhua Hospital between June 2017 and January 2021 were enrolled, and their clinical data were retrospectively collected and a number of serological biomarkers concentrations were analyzed. Patients were categorized into mild and moderate-to-severe disease groups. Univariate and multivariate logistic regression was used to predict moderate-to-severe endoscopic activities, which were then incorporated into a nomogram to establish a prediction scoring model. RESULT Overall, 231 patients were divided into a mild group (n = 111, 48.0%) and a moderate-to-severe group (n = 120, 52.0%). The following variables were independently associated with the disease severity and were subsequently included into the prediction model: Proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA), C-reactive protein (CRP), hemoglobin(Hb), IL-10, stool frequency ≥ 5 times/day and hematochezia. Incorporating these 6 factors, the nomogram showed good discrimination with C-index of 0.819 and reliable calibration. A scoring model was established with the area under the curve 0.818. Moreover, PR3-ANCA and CRP correlated with the duration of hospital stay. CONCLUSION We developed a predictive model for endoscopic disease activities by using noninvasive factors based on PR3-ANCA, CRP, Hb, IL-10, stool frequency and hematochezia. This prediction model might assist clinicians in managing patients with UC.

PURPOSE Increased fecal calprotectin is a sensitive marker of various types of intestinal inflammation. We investigated correlations between high fecal calprotectin concentration and serum inflammatory markers in children with different intestinal diseases with diarrhea with/without blood and/or abdominal pain, to test whether the combination of these markers can differentiate potential patients with inflammatory bowel disease. MATERIALS/METHODS The study included 128 children with high fecal calprotectin concentration (>150ug/g) and symptoms suggesting bowel disorders, hospitalized in the years 2013- 2015. Twenty-six (20%) patients were diagnosed with Crohn's disease, 55 (43%) with ulcerative colitis, 32 (25%) with intestinal infection and 15 (12%) with food protein induced proctocolitis. RESULTS Significantly increased inflammatory markers were detected in children with inflammatory bowel disease, with a correlation between calprotectin and erythrocyte sedimentation rate - ESR (R = 0.53), mean corpuscular volume - MCV (R=-0.64), red blood cell distribution width (R = 0.56), albumin (R = -0.52), hemoglobin (R = -0.53) only in Crohn's disease patients. To discriminate Crohn's disease patients from patients with intestinal infection and patients with food protein induced proctocolitis, AUC analysis was performed. It revealed that considering ESR, CRP and albumin as additional markers to fecal calprotectin significantly improved diagnostic performance (AUC 0.917, p = 0.038). CONCLUSIONS In children with abdominal pain and/or diarrhea, increased ESR, CRP and decreased albumin combined with a high fecal calprotectin level yields additional diagnostic value in screening potential patients with Crohn's disease. As far as differentiation of ulcerative colitis is concerned, low additional diagnostic value was found when high fecal calprotectin was combined with albumin.

Apart from endoscopic interventions, readily attainable cost-effective biomarkers for ulcerative colitis (UC) assessment are required. For this purpose, we evaluated differential leucocytic ratio, mainly neutrophil–lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) as simple available indicators of disease activity in patients with ulcerative colitis. Study conducted on 80 UC patients who were classified into two groups of 40 each according to Mayo score and colonoscopic findings. Group 1 (active UC) and group 2 (inactive UC). Another 40 group-matched healthy participants were enrolled. White blood cell count, NLR, LMR, C-reactive protein, and Erythrocyte sedimentation rate were measured and recorded. Significant elevation of NLR was observed in active UC group compared to inactive UC and controls (2.63 ± 0.43, 1.64 ± 0.25, 1.44 ± 0.19 respectively; p < 0.0001). The optimal NLR cut-off value for active UC was > 1.91, with a sensitivity and a specificity of 90% and 90% respectively. The mean LMRs of active UC was significantly lower compared with inactive UC patients and controls (2.25 ± 0.51, 3.58 ± 0.76, 3.64 ± 0.49 respectively; p < 0.0001). The cut-off value of LMR for determining the disease activity was ≤ 2.88 with a sensitivity of 90% and a specificity of 90%. NLR, LMR, and CRP were found to be significant independent markers for discriminating disease activity (p = 0.000). Besides, NLR was significantly higher in patients with pancolitis and positively correlated with endoscopically severe disease. NLRs and LMRs are simple non-invasive affordable independent markers of disease activity in UC.

Inflammatory bowel disease (IBD) is a life-long illness; accordingly, the early recognition of the illness activity is significant for the management and prevention of complications. We aimed to assess the association between Hs-CAR, markers of inflammation, and CBC parameters in inflammatory bowel disease cases and their impact on illness activity. This study involved 100 Egyptian participants, comprising 80 individuals with IBD: 40 with active illness and 40 in remission, together with a control group of 20 healthy adults. Participants were chosen from the Outpatient Clinics of the Internal Medicine Departments at Al Zahraa University Hospital and Ain-Shams University Hospital in Egypt. The results revealed that CAR displayed a highly significant variance among the groups under investigation (P-value equal 0.003). Moreover, CAR was significantly higher in active CD patients compared to CD in the remission group and ulcerative colitis (UC) cases. In UC patients, CAR had a positive correlation with erythrocyte sedimentation rate (ESR), NLR, lymphocytes, and neutrophils. In CD patients, CAR was positively correlated with ESR, NLR, platelet (PLT), and lymphocytes. The UC-Mayo score and Crohn's disease activity index (CDAI) have been positively correlated with ESR and CAR. The assessment of IBD activity by CAR is a non-invasive and easily accessible instrument. Furthermore, CAR was significantly greater in inactive IBD groups compared to IBD in remission groups. It is concluded that Hs-CAR is a promising non-invasive biomarker for early identification of IBD disease activity and severity, indicating a balance between nutritional status and inflammation.

Introduction: Blood C-reactive protein (CRP) and fecal calprotectin levels are routinely measured as surrogate markers of disease activity in Inflammatory Bowel Disease (IBD), but often do not correlate well with the degree of mucosal inflammation in the intestine as established by endoscopy. Therefore, novel predictive biomarkers are urgently needed that better reflect mucosal disease activity in IBD. The aim of this study was to identify a combination of serum inflammatory biomarkers predictive for endoscopic disease activity. Methods: Serum concentrations of 10 inflammatory biomarkers were analyzed in 118 IBD patients [64 Crohn's disease (CD), 54 ulcerative colitis (UC)] and 20 healthy controls. In a subset of 71 IBD patients, endoscopic disease activity was established. Non-parametric ROC estimation with bootstrap inference was used to establish the best combination of inflammatory biomarkers predicting endoscopic disease activity. Results: Six (6) inflammatory biomarkers (serum amyloid A (SAA), Eotaxin-1, IL-6, IL-8, IL-17A, and TNF-α) showed better prediction of IBD disease activity than routine measures (CRP, fecal calprotectin and HBI/SCCAI scores). The best combination of predictive inflammatory biomarkers consisted of serum SAA, IL-6, IL-8, and Eotaxin-1, showing an optimism-adjusted area under the ROC (AuROC) curve of 0.84 (95% CI: 0.73–0.94, P < 0.0001), which predicted significantly better (P = 0.002) than serum CRP levels with an AuROC of 0.57 (95% CI: 0.43–0.72, P = 0.32). Conclusion: The combination of SAA, IL-6, IL-8, and Eotaxin-1 reliably predicts endoscopic disease activity in IBD and might be valuable for monitoring disease activity and management of the disease.

… were categorized using integer cut points guided by the ROC curves and observed relationship with diagnosis. The final scoring system for the diagnosis of IBD included SC>852 ng/ml, …

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.

Inflammatory Bowel Disease (IBD) is a group of chronic intestinal diseases, among which Crohn’s disease (CD) and ulcerative colitis (UC) represent the two main types. The differential diagnosis of these two disorders is often a significant challenge, as there is a lack of specific and non-invasive biomarkers. In this study, we assessed the serum profile of proinflammatory mediators (E- and P-selectin, CCL2, IL-1α, IL-12p70, TNF-α) in patients with IBD to identify biomarkers helpful in the differential diagnosis of CD and UC. The conducted statistical analyses revealed a significant increase in E-selectin, P-selectin, IL-1α, and IL-12p70 levels in the serum of CD patients compared to UC. The performed ROC curve analysis identified moderate values of E-selectin (AUC 0.752), P-selectin (AUC 0.733), and IL-1α (AUC 0.731) in differentiating CD from UC, while IL-12p70 presented a satisfactory value (AUC 0.695). Simultaneous measurements of each biomarker with serum calprotectin improved the ability of E-selectin (AUC 0.752 vs. 0.829), P-selectin (AUC 0.733 vs. 0.75), IL-1α (AUC 0.731 vs. 0.778), and IL-12p70 (AUC 0.695 vs. 0.714) to differentiate CD from UC. Moreover, we identified a significant relationship between the concentration of CCL2 (r = 0.566, p < 0.005) and TNF-α (r = 0.431, p < 0.05) and the disease activity expressed as the Mayo score in the UC group. We also identified a significant relationship between the concentration of E-selectin (r = 0.372, p < 0.05), CCL-2 (r = 0.55, p < 0.05), IL-1α (r = 0.637, p < 0.005), and TNF-α in the group of patients with UC. Another significant correlation in the UC group was noted in the case of E-selectin and IL-12p70 (r = 0.542, p < 0.05), as well as between IL1-α and P-selectin (r = 0.514, p < 0.05). The results obtained in this study indicate the potential use of E-selectin, P-selectin, IL-1α, and IL-12p70 serum profiles in differentiating CD from UC. Regarding the significant relationship of CCL2 and TNF-α with the Mayo score, these two biomarkers might be useful in assessing and monitoring the disease activity during UC.

Background Serum albumin (ALB) may be low during acute inflammation, but it is also affected by nutritional status. Therefore, we hypothesized that ALB and the C-reactive protein/ALB ratio (CRP/ALB) may be associated with disease activity in patients with Crohn’s disease (CD). Material/Methods Altogether, 100 patients with CD and 100 age- and sex-matched healthy volunteers were retrospectively enrolled in the current study. The patients with CD were subdivided into patients with active disease (Crohn’s Disease Activity Index >150) and those in remission. ALB levels, CRP levels, and lipid profiles were measured. Results ALB and CRP levels and the CRP/ALB ratio were the most useful for differentiating between active and nonactive CD. ALB levels (r=−0.50, P<0.01), CRP levels (r=0.39, P<0.01), and CRP/ALB ratio (r=0.42, P<0.01) all correlated with CD activity. These correlations were more prominent in males. Receiver Operating Characteristic (ROC) analysis indicated that the area under the curve (AUC) representing ALB (0.79) was higher than the AUC representing CRP (0.73) or CRP/ALB ratio (0.75; P>0.05). The AUCs corresponding to ALB level, CRP level, and CRP/ALB ratio were more prominent in males versus females (P<0.05). CRP level (14.55 mg/L), ALB level (34.35 g/L), and CRP/ALB ratio (0.69) had sensitivities of 67.7%, 72.6%, and 59.7%, and specificities of 73.7%, 78.9%, and 81.6%, respectively, for CD activity. Conclusions In the present retrospective study, we found that ALB level and CRP/ALB ratio were useful biomarkers for identifying CD activity, especially in males. These results suggest that, in addition to inflammation, assessment of patient nutritional status could also aid in identifying CD activity.