Prediction of Mucosal Health by NLR, CRP x NLR and MPV in Ulcerative Colitis: Can Their Availability Change According to Treatment Options?

Abstract

IntroductionMucosal healing is the main treatment goal in ulcerative colitis (UC). Many noninvasive parameters have been used in clinical practice to assess mucosal healing. In this study, we aimed to evaluate the effectiveness of neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP) x NLR and mean platelet volume (MPV) in predicting mucosal health. MethodThis study was designed as a retrospective and single-center. A total of 165 patients, 126 active and 39 in remission, were included in this study. The patients were divided into two groups. The patients were divided into two groups. Group-1 consisted of newly diagnosed patients and patients using only mesalazine; Group-2 was including patients using CS and/or AZT plus mesalazine for at least one month. The relationship between Rachmilewitz endoscopic activity index (EAI) and erythrocyte sedimentation rate (ESR), CRP, NLR, CRP x NLR, MPV and platelet (PLT) was evaluated. Using receiver operating characteristic curves, cut-off values were determined for these parameters to predict active disease. ResultsA positive correlation was found between CRP, PLT and NLR and EAI (p<0.001). A negative correlation was found between MPV and EAI (p<0.001). The accuracy of CRP, NLR, CRP x NLR and PLT (2.65 mg/dl, 2.06, 4.29 and 278.5 x 10 9 /L at the indicated cut-off values, respectively) in detecting disease activity was 77.0%, 65.1%, 77.0% and 72.2%, respectively. MPV was not statistically significant in predicting disease activation (p> 0.05). ConclusionCRP and CRP x NLR are significant non-invasive markers for detecting mucosal health in UC. In addition, these markers can be used to evaluate mucosal health regardless of treatment types.

Platelet, Mean Platelet Volume and Platelet Distribution Width Levels Might Be a Promising Marker for the Prediction of Disease Severity, Mucosal Healing and Steroid Dependence in Patients With Ulcerative Colitis

“…They reported that the active phase of the disease could be detected with MPV cut-off level <8.2 fL (60.0% Sensitivity and 77.5% Specificity) and PDW cut-off level <16.6 fL (60.0% Sensitivity and 77.5% and Specificity). Cifci et al [ 11 ] found that UC disease severity was positively correlated with CRP, and PLT levels and negatively correlated with MPV. They reported that PLT level was predictive in the detection of MH (Cut-off value <278.6x10 3 /µL; Sensitivity and 72.2% Specificity 46.2%), but MPV levels were not statistically significant.…”

“…Activation of platelets plays a role in determining and managing mucosal inflammation in the active phase of UC by affecting cytokine levels, such as IL-1, beta-tromboglobulin, platelet-derived growth factor, platelet activation factor, platelets factor 4 [10,16]. Finally, it is known that MPV and PDW levels show influence during exacerbations of chronic inflammation [8][9][10][11][12][13]. In the present study, we aimed to determine the predictive value of PLT, MPV, and PDW levels in detecting disease activation, disease severity, and MH in patients with UC.…”

“…In some studies, it has been reported that there is a positive correlation between disease severity and PLT level, and a negative correlation between MPV and PDW levels [9][10][11][12][13]. Yüksel et al [9] reported that MPV level was lower in UC patients than in the normal population, and it was lower in active patients than in remission patients.…”

“…It is known that mean platelet (PLT) volume (MPV), PLT, and PLT distribution width (PDW) levels change during the activation period of many chronic inflammatory diseases [8]. In clinical studies, especially in the active phase of UC, compared to both the normal population and patients with UC in the remission phase; It has been reported that there is an increase in PLT levels and a decrease in MPV and PDW levels [9][10][11][12][13]. Activation of PLT is also observed during the exacerbation period of UC.…”

“…However, PLT abnormalities and changes in megakaryopoiesis are caused by an inflammatory state on low MPV, PDW and reticulated PLT values during the course of UC [14]. It has been shown in some studies, that UC disease activation severity and prognosis were positively correlated with PLT and negatively correlated with MPV and PDW [9][10][11][12][13]. In our study, we planned to investigate the value of MPV, PLT and PDW levels as a marker for the prediction of MH and SD in newly diagnosed moderately and severely active patients with UC, who did not receive medical treatment before.…”