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Decreased CD8+CD28+/CD8+CD28- T cell ratio can sensitively predict poor outcome for patients with complicated Crohn
Shi-Xue Dai1, Hong-Xiang Gu, Qian-Yi Lin
1Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, South China University of Technology Department of Gastroenterology, Nanfang Hospital The First Clinical Medical School (Nanfang Hospital), Southern Medical University, Guangzhou, Guangdong Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University Department of Anatomy & Cell Biology, Brody School of Medicine, East Carolina University, Greenville, NC, USA School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
Insights
The CD8CD28/CD8CD28 cell balance can predict active Crohn disease (CD) stages in complicated CD patients. A ratio below 1.03 indicates a higher risk of disease activity and worse outcomes.
Area of Science:
- Immunology
- Gastroenterology
- Clinical Medicine
Background:
- Complicated Crohn disease (CD) involves penetrating, stricturing, or perianal disease.
- Identifying predictors of disease activity is crucial for managing complicated CD.
- The CD8CD28/CD8CD28 T cell balance is a potential biomarker.
Purpose of the Study:
- To evaluate the efficiency of the CD8CD28/CD8CD28 cell balance in predicting subsequent active stages in newly diagnosed complicated CD patients.
- To compare risk factors between complicated and uncomplicated CD patients.
- To analyze the predictive value of the CD8CD28/CD8CD28 ratio for disease activity.
Main Methods:
- Enrolled 17 complicated CD patients and 48 uncomplicated CD patients.
- Assessed blood CD8 T cells at diagnosis and during a 30-week follow-up.
- Utilized receiver-operating characteristic curves and Kaplan-Meier analysis for prediction and remission rates.
Main Results:
- Complicated CD patients were younger, predominantly male, with lower BMIs, higher CDAIs, and higher rates of steroid/surgery use.
- Lower CD8CD28/CD8CD28 ratios were observed in complicated CD patients throughout follow-up.
- The CD8CD28/CD8CD28 ratio accurately predicted active CD stages, with optimal sensitivity (89.2%) and specificity (85.3%) at a ratio of 1.03.
Conclusions:
- A decreased CD8CD28/CD8CD28 ratio is associated with more severe disease activity and worse outcomes in complicated CD.
- The CD8CD28/CD8CD28 ratio serves as a sensitive predictor of active disease in complicated CD.
- Monitoring CD8CD28/CD8CD28 ratios, especially when <1.03, warrants increased clinical attention for complicated CD patients.
Abstract:
Crohn disease (CD) with complications such as penetrating, stricturing, and perianal disease is called complicated CD. The aim of this study is to test the efficiency with which the CD8CD28/CD8CD28 cell balance can predict a subsequent active stage in patients with newly diagnosed complicated CD.Seventeen patients with complicated CD and 48 CD patients with no complications were enrolled. Blood CD8 T cells were tested from all of the 65 newly diagnosed CD patients upon enrollment. The potential risk factors were compared between the 2 groups. A 30-week follow-up was performed, and the efficiency of the CD8 cell balance at predicting active CD was analyzed using receiver-operating characteristic curves. The cumulative remission lasting rates (CRLRs) were analyzed using the Kaplan-Meier method.Compared with the control CD group, patients with complicated CD were predominantly male and younger in age; they also had lower body mass indices (BMIs), higher Crohn disease activity indices (CDAIs), higher immunosuppressant and steroid prescription rates, and significantly higher surgical rates. The CD8CD28/CD8CD28 balance was associated with BMI, CDAI, steroids, and surgery. The CD8CD28/CD8CD28 ratios were significantly lower at week 0 and on the 6th, 22nd, and 30th week during follow-up with a shorter lasting time of remission for the complicated CD patients. The CD8CD28/CD8CD28 ratio could accurately predict the active stage for the patients with complicated CD, and the highest sensitivity (89.2%) and specificity (85.3%) were found when the ratio was 1.03. Treatment with steroids and surgery, along with a significantly lower CD8CD28/CD8CD28 ratio and lower CRLRs, was closely related to a worse outcome for the patients with complicated CD.Patients requiring steroids and surgery experience more severe disease activity and thus a disequilibrated immunological balance, which could be the main reason for a decreased CD8CD28/CD8CD28 ratio. This ratio can sensitively predict the active stage for patients with complicated CD, and more care should be taken when this ratio is <1.03.
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