Cesaro Nicola, Valvano Marco, Monaco Sabrina, Stefanelli Gianpiero, Fabiani Stefano, Vernia Filippo, Necozione Stefano, Viscido Angelo, Latella Giovanni
Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi, L'Aquila, Italy.
Division of Gastroenterology, Galliera Hospital, Genoa, Italy.
Eur J Gastroenterol Hepatol. 2025 Jan 1;37(1):24-32. doi: 10.1097/MEG.0000000000002842. Epub 2024 Sep 12.
Inflammatory indices are promising indicators that can be used to evaluate inflammation in inflammatory bowel diseases (IBDs). The present study aimed to investigate the test accuracy of several inflammatory indices to identify endoscopic, and histological activity in a cohort of IBD patients.
All IBD patients who underwent colonoscopy and blood examination (within 4 weeks and without therapeutic change) were included. For these patients, 10 different inflammatory biomarkers were collected. Our primary outcome was the assessment of accuracy [evaluated with a receiver operating characteristics (ROC) analysis] of each inflammatory biomarker and indices. Furthermore, we tried to establish the optimal cutoff to identify patients with endoscopic and histologic activity among the inflammatory biomarkers and indices with higher performance.
Regarding endoscopic activity, at the ROC analysis, the systemic inflammation response index (SIRI) showed the best accuracy [area under the curve (AUC), 0.627; confidence interval (CI), 0.552-0.698]. Whereas the ROC analysis showed a suboptimal AUC for the neutrophil-to-lymphocytes ratio (NLR) and platelets-to-lymphocytes ratio; (AUC, 0.620; CI, 0.545-0.691 and AUC, 0.607; CI, 0.532-0.679, respectively). Concerning histological activity, the C-reactive protein albumin ratio (CAR) presented a higher accuracy among the calculated inflammatory biomarkers (AUC, 0.682; CI, 0.569-0.781) while SIRI and NLR presented a subdued diagnostic performance.
SIRI and CAR presented the best test accuracy in an IBD outpatient setting to identify endoscopic and histological activity. However, the test accuracy of all the evaluated Inflammatory indices appeared suboptimal. Fecal calprotectin has still the highest accuracy in predicting endoscopic and histological activity in patients with IBD.
炎症指标是很有前景的指标，可用于评估炎症性肠病（IBD）中的炎症情况。本研究旨在调查几种炎症指标在一组IBD患者中识别内镜及组织学活动的检测准确性。
纳入所有接受结肠镜检查和血液检查（4周内且无治疗改变）的IBD患者。为这些患者收集了10种不同的炎症生物标志物。我们的主要结局是评估每种炎症生物标志物和指标的准确性[通过受试者操作特征（ROC）分析进行评估]。此外，我们试图在表现更佳的炎症生物标志物和指标中确定识别具有内镜及组织学活动患者的最佳临界值。
关于内镜活动，在ROC分析中，全身炎症反应指数（SIRI）显示出最佳准确性[曲线下面积（AUC），0.627；置信区间（CI），0.552 - 0.698]。而ROC分析显示中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值的AUC次优；（分别为AUC，0.620；CI，0.545 - 0.691和AUC，0.607；CI，0.532 - 0.679）。关于组织学活动，在计算出的炎症生物标志物中，C反应蛋白与白蛋白比值（CAR）表现出更高的准确性（AUC，0.682；CI，0.569 - 0.781），而SIRI和NLR的诊断性能较低。
在IBD门诊患者中，SIRI和CAR在识别内镜及组织学活动方面表现出最佳检测准确性。然而，所有评估的炎症指标的检测准确性似乎都不太理想。粪便钙卫蛋白在预测IBD患者的内镜及组织学活动方面仍具有最高的准确性。
