Aziz Bishoi, Belaghi Reza, Huynh Hien, Jacobson Kevan, Mack David R, Deslandres Colette, Otley Anthony, DeBruyn Jennifer, El-Matary Wael, Crowley Eileen, Sherlock Mary, Critch Jeffery, Ahmed Najma, Griffiths Anne, Walters Thomas, Wine Eytan
Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Alberta, Edmonton, Alberta, Canada.
Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
Clin Transl Gastroenterol. 2025 Apr 1;16(4):e00824. doi: 10.14309/ctg.0000000000000824.
Neutrophil-to-lymphocyte ratio (NLR) is a novel biomarker studied in several autoimmune diseases including inflammatory bowel disease (IBD) in adults but poorly characterized in pediatric IBD (pIBD). We aimed to primarily investigate the relationship between NLR and pIBD endoscopic disease severity. We also examined whether NLR predicted hospitalization, surgery, and therapy response by 52 weeks.
We used the Canadian Children IBD Network prospective inception cohort including patients < 18 years old with baseline data from 2013 to 2022. We excluded patients with concurrent diseases affecting NLR. Both Mayo endoscopic score (MES) and simple endoscopic scale for Crohn's disease (SES-CD) were dichotomized as low activity (quiescent-mild) and high activity (moderate-severe). For therapy responses, we examined year-1 steroid- and biologic-free remission. We used logistic regression for binary outcomes.
A total of 580 patients with ulcerative colitis and 1,081 patients with CD were included. High NLR was associated with high-activity MES and SES-CD in both univariate and multivariable analyses (odds ratio = 1.45, 95% CI = 1.07-1.97, P value = 0.016; and odds ratio = 1.42, 95% CI = 1.04-1.94, P value = 0.026, respectively). We also calculated the best NLR cutoff point to predict MES (1.90, sensitivity = 68%, specificity = 67%, area under the curve [AUC] = 0.67, AUC 95% CI = 0.59-0.74) and SES-CD (2.50, sensitivity = 63%, specificity = 69%, AUC = 0.66, AUC 95% CI = 0.59-0.75) high activity. NLR did not predict therapy response in either ulcerative colitis or CD.
Patients with pIBD with high baseline NLR are more probable to have worse endoscopic disease at diagnosis. This highlights NLR potential as a reliable noninvasive biomarker of disease activity. The predictive power of NLR is based mostly on neutrophils and the balance between neutrophils and lymphocytes.
中性粒细胞与淋巴细胞比值（NLR）是一种新的生物标志物，已在包括成人炎症性肠病（IBD）在内的多种自身免疫性疾病中进行研究，但在儿童IBD（pIBD）中的特征尚不明确。我们旨在主要研究NLR与pIBD内镜疾病严重程度之间的关系。我们还研究了NLR是否能预测52周内的住院、手术及治疗反应。
我们使用了加拿大儿童IBD网络前瞻性起始队列，纳入了2013年至2022年有基线数据的18岁以下患者。我们排除了患有影响NLR的并发疾病的患者。梅奥内镜评分（MES）和克罗恩病简易内镜评分（SES-CD）均分为低活动度（静止-轻度）和高活动度（中度-重度）。对于治疗反应，我们考察了1年无类固醇和生物制剂缓解情况。我们对二元结局使用逻辑回归分析。
共纳入580例溃疡性结肠炎患者和1081例克罗恩病患者。在单变量和多变量分析中，高NLR均与高活动度MES和SES-CD相关（比值比分别为1.45，95%置信区间为1.07-1.97，P值=0.016；以及比值比为1.42，95%置信区间为1.04-1.94，P值=0.026）。我们还计算了预测MES（1.90，灵敏度=68%，特异度=67%，曲线下面积[AUC]=0.67，AUC 95%置信区间为0.59-0.74）和SES-CD（2.50，灵敏度=63%，特异度=69%，AUC=0.66，AUC 95%置信区间为0.59-0.75）高活动度的最佳NLR截断点。NLR在溃疡性结肠炎或克罗恩病中均不能预测治疗反应。
基线NLR高的pIBD患者在诊断时更有可能有更严重的内镜疾病。这凸显了NLR作为疾病活动可靠的非侵入性生物标志物的潜力。NLR的预测能力主要基于中性粒细胞以及中性粒细胞与淋巴细胞之间的平衡。
