Monocytosis and a Low Lymphocyte to Monocyte Ratio Are Effective Biomarkers of Ulcerative Colitis Disease Activity

Abstract

Background Current biomarkers in ulcerative colitis (UC) are limited by their performance, cost and limited availability in daily practice. This study examined alterations in the leukocyte profiles as biomarkers of UC activity including the effects of age, gender and medications. Methods Case control study that included 110 UC subjects, 75 subjects with C. difficile infection, and 75 non-inflammatory bowel disease (IBD) subjects, randomly selected from a single institution IBD database. Mean values of neutrophils (N), lymphocytes (L), monocytes (M) and their ratios were compared between groups. ROC curve analyses assessed the performance of each biomarker in discriminating disease states. Subgroup analyses examined leukocytes profiles with endoscopic activity. Results Elevated monocyte counts and decreased L/M values significantly differed between subjects with active UC and UC in remission and performed better than other leukocyte profiles. A monocyte count of 483 and L/M ratio of 3.1 were 60% sensitive and had a specificity of 61% and 53% respectively for active UC. Monocyte count > 860 and L/M value < 1.6 had a 75% positive predictive value for UC activity. Those markers also correlated with endoscopically active disease. L/M and N/L values performed best at differentiating active UC from non-IBD controls, while N/L and neutrophil values performed best at differentiating from C. diff controls. Conclusion Monocytosis and a low L/M ratio might be effective, readily available and low cost biomarkers to identify disease activity in UC patients. N/L values were more effective at distinguishing active UC patients from patients without IBD and those with C. diff infection.

The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis

“…The NLR and LMR were evaluated in a case-control study for differentiation of active ulcerative colitis (UC) from UC in remission and from C. difficile infection ( n = 75; diagnosed by detection of toxin A or B by PCR in stool and with no history of inflammatory bowel disease) and healthy controls without gastrointestinal disease ( n = 75). 51 Although the authors' analysis aimed to describe these ratios in the context of UC, sufficient data were presented to compare C. difficile infection with the healthy controls. The LMR was lower in C. difficile infection compared to healthy controls (mean 1.5 vs 3.5) and the NLR was higher (mean 7.0 vs 2.6).…”

How I investigate monocytosis

“…That said, greater focus is given to CMML, as it is the most common neoplastic diagnosis made once other rare and/or genetically defined entities have been excluded. Chronic infections (eg, viral, tuberculosis, malaria, subacute bacterial endocarditis, and congenital syphilis) [21][22][23][24] Immune/inflammatory disorders (eg, collagen vascular diseases, inflammatory bowel disease, sarcoidosis, and immune thrombocytopenia) 21,25,26 Myocardial infarction 27 Sickle cell disease and other hemolytic anemias 28,29 Chronic stress 30…”

“…Immune/inflammatory disorders (eg, collagen vascular diseases, inflammatory bowel disease, sarcoidosis, and immune thrombocytopenia) 21,25,26 Myocardial infarction 27 Sickle cell disease and other hemolytic anemias 28,29 Chronic stress 30 …”

Inflammatory Bowel Disease Clinical

“…As targeted biological therapies become more easily available and diverse, there is growing interest in identifying patients who are most likely to require biological therapy to provide early and adequate disease control. Recent data suggest that monocytosis is a useful biomarker that is associated with severe disease . We performed a retrospective cohort analysis of patients with IBD at our institution to better understand the local epidemiology of IBD and investigate the relationship between monocytosis and disease severity using surrogate end points of penetrating Crohn's disease, use of biological therapy, and IBD‐related surgery.…”