Histologic Activity Modifies the Predictive Value of Systemic Inflammatory Markers in Ulcerative Colitis

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease Research
• Clinical Biomarker Studies

Background:

• Systemic inflammatory markers may predict ulcerative colitis (UC) relapse.
• The impact of histologic activity on their prognostic value is unclear.
• This study investigates inflammatory markers in UC patients with endoscopic improvement.

Purpose of the Study:

• To evaluate if baseline neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-platelet ratio (NPR) predict clinical relapse in UC patients with endoscopic improvement.
• To determine if these associations differ based on histologic status.
• To assess the prognostic value of inflammatory markers in UC relapse prediction.

Main Methods:

• Retrospective cohort study of UC patients with Mayo Endoscopic Subscore 0 or 1.
• Histologic status assessed by Geboes score (improvement <3.1 vs. activity ≥3.1).
• Baseline NLR, LMR, NPR calculated; clinical relapse as primary outcome; Cox models and Kaplan-Meier analyses used.

Main Results:

• Higher baseline NLR predicted relapse in patients with histologic activity (HR 1.72), but not with histologic improvement (HR 0.98).
• High NLR remained associated with relapse in active histology patients after adjustment (HR 1.83), with significant interaction by histology (p=0.019).
• LMR and NPR showed no association with relapse.

Conclusions:

• Histologic activity modifies the prognostic value of baseline NLR in UC patients with endoscopic improvement.
• Combining NLR with histologic assessment may enhance UC relapse risk stratification.
• NLR is a potential predictor of relapse in active UC histology, but not in improved histology.