DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20221490

A study on clinical profile of patients with ulcerative colitis and association of neutrophil-lymphocyte ratio with disease severity

Arun Dhotra, Kani Shaikh, Anand A., Akilandeshawari A. R., Arun N.

Abstract


Background: Ulcerative colitis (UC) is an immune mediated chronic inflammatory condition. Systemic inflammatory conditions like UC are associated with increased WBC count and inflammatory markers. A growing body of evidence suggested that neutrophil-lymphocyte ratio (NLR) is a useful bio-maker of systemic inflammatory response.

Methods: An observational study was carried out at department of digestive health and diseases, government Kilpauk medical college, Chennai, from October 2020 to September 2021. All the patients diagnosed as UC were included. Age and sex matched controls were included. Clinical details and colonoscopic findings and laboratory values including WBC, ESR, NLR were noted and analyzed.

Results: A total of 70 patients of UC came during this period. The 32 patients had active UC and 38 patients had inactive UC. 40 age and sex matched controls were included. Mean age of the patients with UC was 40.76±9.81 years. Out of UC cases, 58.57% were females. Maximum patients presented with bloody diarrhoea (88.57%) and left sided colitis was more common (41.43%). On analyzing laboratory values, the NLR values of active UC group were significantly elevated compared with those of the patients with inactive UC and controls (2.84±0.66, 2.05±0.21 and 1.60±0.25 respectively) p<0.001.

Conclusions: UC is an inflammatory condition with bloody diarrhoea as the primary presenting symptom. NLR was significantly elevated in patients with active disease. NLR is a useful biomarker of systemic inflammatory response and it maybe a promising marker of disease severity in UC. 


Keywords


UC, NLR, Inflammation, Bloody diarrhoea

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References


Singh P, Ananthakrishnan A, Ahuja V. Pivot to Asia: inflammatory bowel disease burden. Intest Res. 2017;15:138-41.

Caprilli R, Viscido A, Latella G. Current management of severe ulcerative colitis. Nat Clin Pract Gastroenterol Hepatol. 2007;4:92-101.

DeRoche TC, Xiao SY, Liu X. Histological evaluation in ulcerative colitis. Gastroenterol Rep (Oxf). 2014;2:178-92.

Mack DR, Langton C, Markowitz J. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics. 2007;119:1113-9.

Xiang JY, Ouyang Q, Li GD, Xiao NP. Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis. World J Gastroenterol. 2008;14:53-7.

Yüksel O, Helvaci K, Bas¸ar O, Köklü S, Caner S, Helvaci N et al. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets 2009;20:277-81.

Xue TC, Zhang L, Xie XY, Ge NL, Li LX, Zhang BH et al. Prognostic significance of the neutrophil-to-lymphocyte ratio in primary liver cancer: a meta-analysis. PLoS ONE. 2014;9:960-72.

Gokmen F, Akbal A, Resorlu H, Gökmen E, Güven M, Aras AB et al. Neutrophil–lymphocyte ratio connected to treatment options and inflammation markers of ankylosing spondylitis. J Clin Lab Anal. 2015;29:294-8.

Li MX, Liu XM, Zhang XF, Zhang JF, Wang WL, Zhu Y et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer. 2014;134:2403-13.

McNamara MG, Templeton AJ, Maganti M, Walter T, Horgan AM, McKeever L et al. Neutrophil/ lymphocyte ratio as a prognostic factor in biliary tract cancer. Eur J Cancer. 2014;50:1581-9.

Demir AK, Demirtas A, Kaya SU, Tastan I, Butun I, Sagcan M et al. The relationship between the neutrophil–lymphocyte ratio and disease activity in patients with ulcerative colitis. Kaohsiung J Med Sci. 2015;31(11):585-90.

Jeong Y, Jeon SR, Kim HG, Moon JR, Lee TH, Jang JY et al. The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis. Intest Res. 2021;19(1):62-70.

Okba AM, Amin MM, Abdelmoaty AS, Ebada HE, Kamel AH, Allam AS et al. Neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio in ulcerative colitis as non-invasive biomarkers of disease activity and severity. Auto Immun Highlights. 2019;10(1):4.

Mendall MA, Jensen CB, Sørensen TIA. Body mass index in young men and risk of inflammatory bowel disease through adult life: A population-based Danish cohort study. Sci Rep. 2019;9:6360.

Rahmani J, Kord-Varkaneh H, Hekmatdoost A, Thompson J, Clark C, Salehisahlabadi A et al. Body mass index and risk of inflammatory bowel disease: A systematic review and dose-response meta-analysis of cohort studies of over a million participants. Obes Rev. 2019;20(9):1312-20.

Dignass A, Eliakim R, Magro F, Maaser C, Chowers Y, Geboes K et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohn's Colitis. 2012;6:965-90.

Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36:491-7.

Çelikbilek M, Dogan S, Ozbakir O, Zararsiz G, Kucuk H, Gursoy S et al. Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal. 2013;27:72-6.

Akpinar MY, Ozin YO, Kaplan M, Ates I, Kalkan IH, Kilic ZMY et al. Platelet-to-lymphocyte Ratio and Neutrophil-to-lymphocyte Ratio Predict Mucosal Disease Severity in Ulcerative Colitis. J Med Biochem. 2018;37(2):155-62.

Ma L, Pang X, Ji G, Ma X, Li J, Chang Y, Ma C. Application of the neutrophil to lymphocyte ratio in the diagnosis and activity determination of ulcerative colitis: A meta-analysis and systematic review. Medicine. 2021;100(42).