What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clinical remission?

Shin, Jongbeom; Kong, S M; Seong, Gyeol; Kim, Young‐Ho

doi:10.1007/s00384-020-03705-9

Cited by 3 publications

(5 citation statements)

References 40 publications

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“…According to findings of the present study, SAA levels did not differ between ulcerative proctitis (E1) patients of both activity and remission groups and in patients with much extensive diseases. This observation goes in agreement with Shin et al, 2020, 21 who found no statistically significant difference in disease extent according to the endoscopic remission status. However, this observation disagreed with that reported by Wakai et al, 2020, 22 who found that the usefulness of SAA may be more enhanced in widespread inflammation such as total colitis than in less extensive disease.…”

Section: Discussionsupporting

confidence: 93%

Serum Amyloid A as a non-invasive predictive biomarker of mucosal healing in ulcerative colitis patients

Khatab

2024

EJI

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Ulcerative colitis is a chronic immune-mediated inflammatory condition of large intestine that is frequently associated with inflammation of the rectum but often extends proximally to involve other areas of the colon. The ultimate target of therapy is complete healing in the form of clinical remission, complete endoscopic and histological healing, and transmural healing for which endoscopy is mandatory. Colonoscopy may not always be applicable due to possible complications in active ulcerative colitis. Therefore, non-invasive biomarkers are needed to avoid the disadvantageous complications of invasive diagnostic procedures. The aim of this study was to evaluate the role of serum Amyloid-A (SAA) as a non-invasive predictive biomarker of mucosal healing in comparison to different laboratory biomarkers, and endoscopic activity scores. The study included 100 ulcerative colitis patients classified into two groups: 50 patients in clinical, and biochemical remission and 50 patients in activity. Complete blood picture, C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and SAA were measured and recorded, colonoscopies with histopathological examination were done for all patients. SAA levels were significantly higher in patients with active ulcerative colitis than in clinical remission patients (p <0.001). In clinical, remission patients without full mucosal healing, SAA was positively correlated with endoscopic disease activity represented with Mayo score, Mayo endoscopic sub-score and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) (p< 0.001). However, there was no significant correlation between SAA and endoscopic scores among the activity patients’ group. The cut off value of SAA for determining disease activity was > 5.199 µg/ml with 100 % sensitivity, specificity of 92 %, and accuracy of 99.6%. In conclusion, SAA can be used for prediction of mucosal healing in ulcerative colitis remission patients despite not being superior to fecal calprotectin. However, it was unable to differentiate between the different disease activities or extents.

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Section: Discussionsupporting

confidence: 93%

Serum Amyloid A as a non-invasive predictive biomarker of mucosal healing in ulcerative colitis patients

Khatab

2024

EJI

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“…19 In addition, there is no optimal threshold of CRP to accurately discriminate active and quiescent conditions. 5 Shin et al 20 found that a normal CRP level (<0.3 mg/dl) also appeared in active UC patients (sensitivity 27.3%). From our results, we speculate that active UC is often accompanied by hematochezia or invisible blood loss from the digestive tract, causing anemia and further aggravation of ESR changes.…”

Section: Discussionmentioning

confidence: 99%

Bowel ultrasound enhances predictive value based on clinical indicators: a scoring system for moderate-to-severe endoscopic activities in patients with ulcerative colitis

Zhang

Zhu

et al. 2021

Therap Adv Gastroenterol

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Background and Aim: The aim was to assess non-invasive factors among clinical features, laboratory, and bowel ultrasound (BUS) characteristics and to develop a scoring system to predict endoscopic activities for ulcerative colitis (UC) patients. Methods: We performed a retrospective study collecting UC patients between January 2015 to September 2020. Logistic regression was performed to predict moderate-to-severe endoscopic activities, defined as endoscopic Mayo score ⩾2. Model performance was described with discrimination and calibration ability and validated by internal and external methods. Results: A total of 103 and 29 patients were enrolled in the modeling and validation groups, respectively. Stool frequency ⩾5 times/day, hematochezia, erythrocyte sedimentation rate (ESR), and colonic wall flow in BUS were included into two predictive models for endoscopic activities, both with good discrimination ability [Area under curve (AUC) 0.879 and 0.882, p < 0.001] and a sensitivity of 76.7% and specificity of 92.3%, which showed an adequate calibration ability by using the Hosmer–Lemeshow test ( p = 0.14 and 0.07). The external validation displayed consistent results with the above mentioned. Nomograms were also established for these models. Conclusion: We developed predictive models for endoscopic disease activities by using noninvasive factors based on stool frequency, hematochezia, ESR, and colonic wall blood flow in BUS. These models performed well in the internal and external validation.

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“…At critical values of 0.3 or 0.5 mg/dL, its sensitivity and specificity are poor [ 32 ]. In recent years, the sensitivity of CRP detection has been improved [ 8 ]. Hs-CRP can detect values below 0.3 mg/dL and is related to the clinical and endoscopic activity of UC [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the sensitivity of CRP detection has been improved [ 8 ]. Hs-CRP can detect values below 0.3 mg/dL and is related to the clinical and endoscopic activity of UC [ 8 ]. In the MES group and MES-E3 groups, the cutoff values of hs-CRP for endoscopic activity were 5.32 mg/L (AUC 0.850, sensitivity 77.6%, specificity 81.9%) and 5.16 mg/L (AUC 0.902, sensitivity 86.9%, specificity 85.4%), respectively, showing good diagnostic efficacy in evaluating endoscopic activity.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it requires the collection of fecal sample which is cumbersome and has poor patient acceptability [ 6 , 7 ]. High sensitivity C-reactive protein (hs-CRP) has attracted interest in UC in recent years due to its high sensitivity and accuracy, and its relationship with the clinical and even EA of inflammatory bowel disease (IBD) [ 8 ]. It has been found that hs-CRP can better reflect the inflammation of the colonic mucosa than fecal calprotectin, and can reliably identify pancolitis [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Common laboratory blood test immune panel markers are useful for grading ulcerative colitis endoscopic severity

Cui

Zhang

et al. 2022

BMC Gastroenterol

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Background At present, many indicators reflect the clinical disease activity of ulcerative colitis (UC). However, commonly used inflammatory markers do not show good utility for indicating endoscopic disease activity. The purpose of this study was to evaluate high sensitivity C-reactive protein (hs-CRP), C-reactive protein to albumin ratio (CAR), inflammatory markers, and complete blood count (CBC) related parameters in patients with UC as simple, non-invasive, and independent markers of endoscopic activity (EA). Methods We retrospectively collected extensive data from the hospital medical records of 386 patients who presented with UC to the First Affiliated Hospital of Xinjiang Medical University (Urumqi, China) from 2018 to 2022 January. The Mayo endoscopic score (MES) was used to evaluate endoscopic disease activity. All included patients were defined as the MES-All group; those with extensive colitis (E3) were defined as the MES-E3 group. Demographics, laboratory parameters, endoscopic results, the extent of disease, and drug history were recorded and analyzed. Results For patients in the MES-All or MES-E3 group, hs-CRP, CAR, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were significantly higher in EA UC patients than in those with mucosal healing. The mean platelet volume (MPV) and lymphocyte to monocyte ratio were significantly lower in active disease than in the patient’s remission (p < 0.001). ROC analysis showed that in the MES-All and MES-E3 groups, the cutoff values of hs-CRP activity under endoscopy were 5.32 mg/L (AUC 0.850, sensitivity 77.6%, specificity 81.9%) and 5.16 mg/L (AUC 0.902, sensitivity 86.9%, specificity 85.4%) respectively, and the cutoff values of CAR were 0.14 (AUC 0.853, sensitivity 76.8%, specificity 84.8%) and 0.18 (AUC 0.904, sensitivity 81.8%, specificity 89.6%) respectively. Multivariate logistic regression analysis showed that hs-CRP, CAR, NLR, and PLR identified UC EA, while decreased MPV reflected inflammatory activity in the UC mucosa. Conclusion Especially in patients with extensive colitis, hs-CRP and CAR are closely related to EA and show a higher diagnostic value compared to the related CBC parameters. The aforementioned indicators are simple and non-invasive independent markers that reflect the EA in UC.

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What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clinical remission?

Cited by 3 publications

References 40 publications

Serum Amyloid A as a non-invasive predictive biomarker of mucosal healing in ulcerative colitis patients

Serum Amyloid A as a non-invasive predictive biomarker of mucosal healing in ulcerative colitis patients

Bowel ultrasound enhances predictive value based on clinical indicators: a scoring system for moderate-to-severe endoscopic activities in patients with ulcerative colitis

Common laboratory blood test immune panel markers are useful for grading ulcerative colitis endoscopic severity

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