Clinical Significance of Novel Neutrophil-Based Biomarkers in the Diagnosis and Prediction of Response to Infliximab Therapy in Crohn’s Disease

Abstract

With the increasing incidence and prevalence, Crohn’s disease (CD) has become one of the most challenging diseases in both diagnosis and treatment of gastroenterology. Evaluation of the disease activity and mucosal healing guides clinical decisions regarding subsequent therapy for CD. In this study, we enrolled a total of 144 patients with CD and 239 healthy controls were enrolled. Clinical characteristics and laboratory parameters of enrolled subjects were retrieved from the electronic medical record database of our hospital. Serum cytokine levels were measured by enzyme-linked immunosorbent assay (ELISA). Mucosa expression levels of inflammatory agents were measured by quantitative RT-PCR (qRT-PCR). We identified two neutrophil-based indexes, the neutrophil-to-albumin ratio (NAR) and neutrophil-to-bilirubin ratio (NBR), both of which had not yet been explored in CD or UC. NAR and NBR were significantly increased in patients with CD compared to those in healthy controls, and both indexes showed significantly positive correlations with CD activity and inflammatory load. In note, NAR and NBR showed better performance than blood neutrophil percentage, serum albumin, or bilirubin alone in these scenarios. More importantly, both NAR and NBR discriminated CD patients who completely or partially responded to infliximab (IFX) induction therapy from those with primary non-response. Our observations suggest that NAR and NBR may serve as promising biomarkers in the diagnosis and prediction of response to IFX therapy in CD.

The Neutrophil-to-Albumin Ratio (NAR): A Novel Index in Relation to Clinical Symptoms, Quality of Life, and Psychological Status in Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D)

“…NAR has been observed to be significantly increased in patients with IBD, and it has shown positive correlations with both systemic and mucosal inflammation. 9,11 In this study, we underscored the clinical significance of NAR as a biomarker in IBS. Its associations with symptom severity, quality of life (QOL), and inflammatory mediators highlight its potential in guiding treatment strategies and improving patient outcomes.…”

“…The neutrophil-to-albumin ratio (NAR) has garnered attention as a valuable marker of systemic inflammation in various medical conditions, including inflammatory diseases, vascular disorders, and cancers. [7][8][9][10][11] Combining blood cell counts and serum biochemical indices, NAR has emerged as an informative parameter in clinical research. Studies have demonstrated the utility of NAR as a diagnostic and prognostic marker in different contexts.…”

C-reactive protein-to-albumin ratio and neutrophil-to-albumin ratio for predicting response and prognosis to infliximab in ulcerative colitis

“…Therefore, timely and effective assessment of drug efficacy is crucial to the prognosis of patients, avoiding delays in treatment and reducing the cost of treatment for patients. Single biomarkers have limitations in predicting disease progression, prompting increased research into combining multiple biomarkers, for example, NAR forecasted the reaction to IFX in Crohn’s disease (CD) patients ( 6 ), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were used as new biomarkers of mucosal prognosis for UC patients receiving anti-TNF therapy ( 7 , 8 ).…”

Clinical Utility of the Neutrophil-to-Bilirubin Ratio in the Detection of Disease Activity in Ulcerative Colitis

“…Recently, we identified a novel serological index, the neutrophil-to-bilirubin ratio (NBR), which was effective in monitoring disease activity and predicting response to infliximab (IFX) treatment in patients with Crohn’s disease (CD). 10 However, the use of NBR in UC has not yet been reported. We thus hypothesized that NBR might be useful in monitoring clinical and endoscopic activity in patients with UC.…”