The Predictive Value of Inflammatory Markers in the First Year of Diagnosis in Ulcerative Colitis
Abstract
Objective: The aim of this study was to determine if the changes in inflammatory markers which were observed during the routine follow-up of patients with ulcerative colitis could predict the disease progression.
Methods: Levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin (Hb), white blood cell count (WBC), neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV) and albumin (alb), which were observed at the time of diagnosis as well as in the 3rd, 6th, 9th and 12th months, were recorded retrospectively. The area under the curve (AUC) of the variation of these values with respect to time was calculated.
Results: 118 patients were subjects of this study, with a mean follow-up time of 3.4 years. The calculated AUCs for CRP, ESR, WBC, and NLO were significantly higher ( p<0.001,p<0.01,p<0.01,p<0.01 ); whereas the ones for Hb, alb, and MPV were significantly lower (p<0.01,p<0.001,p<0.05) in patients who used an immunomodulator compared to those who did not. The calculated AUCs for CRP and ESR were significantly higher (p<0.001,p<0.05); whereas the AUCs for Hb, alb, and MPV were significantly lower (p<0.01,p<0.05,p<0.01) in patients who used an anti-tumor necrosing factor-alpha inhibitor (anti-TNF) compared to those who did not. Additionally, in patients who used anti-TNF, the AUCs for CRP were significantly higher ( ), than in patients who only used immunomodulators.
Conclusion: The levels of inflammatory markers in the early course of the disease are helpful for predicting the disease progression and prognosis. We assume that, the higher the CRP, the worse the prognosis.
References
Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1785-94.
Romberg-Camps MJ, Dagnelie PC, Kester AD, Hesselink-van de Kruijs MA, Cilissen M, Engels LG, et.al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. The American journal of gastroenterology. 2009;104(2):371-83.
Solem CA, Loftus EV, Jr., Tremaine WJ, Harmsen WS, Zinsmeister AR, Sandborn WJ. Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflammatory bowel diseases. 2005;11(8):707-12.
Azad S, Sood N, Sood A. Biological and histological parameters as predictors of relapse in ulcerative colitis: a prospective study. Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 2011;17(3):194-8.
Sutherland L, Macdonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. The Cochrane database of systematic reviews. 2006(2):CD000543.
Timmer A, Patton PH, Chande N, McDonald JW, MacDonald JK. Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis. The Cochrane database of systematic reviews. 2016(5):CD000478.
Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. The New England journal of medicine. 2005;353(23):2462-76.
Sahami S, Konte K, Buskens CJ, Tanis PJ, Lowenberg M, Ponsioen CJ, et.al. Risk factors for proximal disease extension and colectomy in left-sided ulcerative colitis. United European gastroenterology journal. 2017;5(4):554-62.
Arsik I, Frediani JK, Frezza D, Chen W, Ayer T, Keskinocak P, et.al. Alanine Aminotransferase as a Monitoring Biomarker in Children with Nonalcoholic Fatty Liver Disease: A Secondary Analysis Using TONIC Trial Data. Children (Basel). 2018;5(6).
Iwasa R, Yamada A, Sono K, Furukawa R, Takeuchi K, Suzuki Y. C-reactive protein level at 2 weeks following initiation of infliximab induction therapy predicts outcomes in patients with ulcerative colitis: a 3 year follow-up study. BMC gastroenterology. 2015;15:103.
Cacheux W, Seksik P, Lemann M, Marteau P. Nion-Larmurier I, Afchain P, et. al. Predictive factors of response to cyclosporine in steroid-refractory ulcerative colitis. The American journal of gastroenterology. 2008;103(3):637-42.
Turner D, Mack DR, Hyams J, LeLeiko N, Otley A, Markowitz J, et.al. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) or both? A systematic evaluation in pediatric ulcerative colitis. Journal of Crohn's & colitis. 2011;5(5):423-9.
Jeon HH, Lee HJ, Jang HW, Yoon JY, Jung YS, Park SJ et.al. Clinical outcomes and predictive factors in oral corticosteroid-refractory active ulcerative colitis. World journal of gastroenterology. 2013;19(2):265-73.
Torun S, Tunc BD, Suvak B, Yıldız H, Tas A, Sayilir A, et.al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clinics and research in hepatology and gastroenterology. 2012;36(5):491-7.
Öztürk ZA, Dag MS, Kuyumcu ME, Cam H, Yesil Y, Yilmaz N, et. al. Could platelet indices be new biomarkers for inflammatory bowel diseases? European review for medical and pharmacological sciences. 2013;17 - N. 3 334-41.
