Neutrophil/lymphocyte Ratio and Lymphocyte/monocyte Ratio in Ulcerative Colitis As Non-invasive Biomarkers of Disease Activity and Severity

Overview

Journal Auto Immun Highlights

Publisher Biomed Central

Date 2020 Apr 8

PMID 32257060

Citations 24

Authors

Ashraf M Okba

Mariam M Amin

Ahmed S Abdelmoaty

Hend E Ebada

Amgad H Kamel

Ahmed S Allam

Omar M Sobhy

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: NLRs and LMRs are simple non-invasive affordable independent markers of disease activity in UC.

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References

Schoepfer A, Beglinger C, Straumann A, Safroneeva E, Romero Y, Armstrong D . Fecal calprotectin more accurately reflects endoscopic activity of ulcerative colitis than the Lichtiger Index, C-reactive protein, platelets, hemoglobin, and blood leukocytes. Inflamm Bowel Dis. 2013; 19(2):332-41. DOI: 10.1097/MIB.0b013e3182810066. View

Rutka M, Milassin A, Szepes Z, Szucs M, Nyari T, Balint A . Is mucosal healing more common than clinical remission in ulcerative colitis? - Is it the truth or only a myth coming from the studies?. Scand J Gastroenterol. 2015; 50(8):985-90. DOI: 10.3109/00365521.2015.1018313. View

Xue T, Zhang L, Xie X, Ge N, Li L, Zhang B . Prognostic significance of the neutrophil-to-lymphocyte ratio in primary liver cancer: a meta-analysis. PLoS One. 2014; 9(5):e96072. PMC: 4008563. DOI: 10.1371/journal.pone.0096072. View

Makkar R, Bo S . Colonoscopic perforation in inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2014; 9(9):573-83. PMC: 3983974. View

Gokmen F, Akbal A, Resorlu H, Gokmen E, Guven M, Aras A . Neutrophil-Lymphocyte Ratio Connected to Treatment Options and Inflammation Markers of Ankylosing Spondylitis. J Clin Lab Anal. 2014; 29(4):294-8. PMC: 6807178. DOI: 10.1002/jcla.21768. View

El-Kheshen G, Moeini M, Saadat M . Susceptibility to Ulcerative Colitis and Genetic Polymorphisms of A251G SOD1 and C-262T CAT. J Med Biochem. 2017; 35(3):333-336. PMC: 5346812. DOI: 10.1515/jomb-2016-0002. View

McNamara M, Templeton A, Maganti M, Walter T, Horgan A, McKeever L . Neutrophil/lymphocyte ratio as a prognostic factor in biliary tract cancer. Eur J Cancer. 2014; 50(9):1581-9. DOI: 10.1016/j.ejca.2014.02.015. View

Sachar D, Taub R, Brown S, Present D, Korelitz B, Janowitz H . Imparied lymphocyte responsiveness in inflammatory bowel disease. Gastroenterology. 1973; 64(2):203-9. View

Demir A, Demirtas A, Kaya S, Tastan I, Butun I, Sagcan M . The relationship between the neutrophil-lymphocyte ratio and disease activity in patients with ulcerative colitis. Kaohsiung J Med Sci. 2015; 31(11):585-90. DOI: 10.1016/j.kjms.2015.10.001. View

10.

THAYER Jr W, Charland C, Field C . The subpopulations of circulating white blood cells in inflammatory bowel disease. Gastroenterology. 1976; 71(3):379-84. View

11.

Macdonald T, Monteleone I, Fantini M, Monteleone G . Regulation of homeostasis and inflammation in the intestine. Gastroenterology. 2011; 140(6):1768-75. DOI: 10.1053/j.gastro.2011.02.047. View

12.

Nakarai A, Kato J, Hiraoka S, Kuriyama M, Akita M, Hirakawa T . Evaluation of mucosal healing of ulcerative colitis by a quantitative fecal immunochemical test. Am J Gastroenterol. 2012; 108(1):83-9. DOI: 10.1038/ajg.2012.315. View

13.

Schoepfer A, Beglinger C, Straumann A, Trummler M, Renzulli P, Seibold F . Ulcerative colitis: correlation of the Rachmilewitz endoscopic activity index with fecal calprotectin, clinical activity, C-reactive protein, and blood leukocytes. Inflamm Bowel Dis. 2009; 15(12):1851-8. DOI: 10.1002/ibd.20986. View

14.

Wallace K, Zheng L, Kanazawa Y, Shih D . Immunopathology of inflammatory bowel disease. World J Gastroenterol. 2014; 20(1):6-21. PMC: 3886033. DOI: 10.3748/wjg.v20.i1.6. View

15.

Shi C, Pamer E . Monocyte recruitment during infection and inflammation. Nat Rev Immunol. 2011; 11(11):762-74. PMC: 3947780. DOI: 10.1038/nri3070. View

16.

Lester S, Proudman S, Lee A, Hall C, McWilliams L, James M . Treatment-induced stable, moderate reduction in blood cell counts correlate to disease control in early rheumatoid arthritis. Intern Med J. 2009; 39(5):296-303. DOI: 10.1111/j.1445-5994.2008.01737.x. View

17.

Lewis J . The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology. 2011; 140(6):1817-1826.e2. PMC: 3749298. DOI: 10.1053/j.gastro.2010.11.058. View

18.

van Rheenen P, van de Vijver E, Fidler V . Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010; 341:c3369. PMC: 2904879. DOI: 10.1136/bmj.c3369. View

19.

Celikbilek M, Dogan S, Ozbakir O, Zararsiz G, Kucuk H, Gursoy S . Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal. 2013; 27(1):72-6. PMC: 6807407. DOI: 10.1002/jcla.21564. View

20.

Li M, Liu X, Zhang X, Zhang J, Wang W, Zhu Y . Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer. 2013; 134(10):2403-13. DOI: 10.1002/ijc.28536. View