Clinical significance of the C-reactive protein-to-bilirubin ratio in patients with ulcerative colitis

Xijing Huang; Ya Liu; Zhou Zhou; Yan Pan; Yinghui Zhang; Caiping Gao; Chong He

doi:10.3389/fmed.2023.1227998

Clinical significance of the C-reactive protein-to-bilirubin ratio in patients with ulcerative colitis

Front Med (Lausanne). 2023 Sep 25:10:1227998. doi: 10.3389/fmed.2023.1227998. eCollection 2023.

Authors

Xijing Huang^#^{1

2}, Ya Liu^#¹, Zhou Zhou¹, Yan Pan¹, Yinghui Zhang¹, Caiping Gao¹, Chong He^{1

2}

Affiliations

¹ Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
² Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

^# Contributed equally.

Abstract

Background: Ulcerative colitis (UC) is a chronic relapsing remitting disease of the colon. Appropriate monitoring of the disease status is necessary for patients to adopt optimal therapy and obtain a better prognosis. Finding an ideal non-invasive biomarker, which is suitable for long-term monitoring in clinical settings will bring a significant benefit to the individualized management of patients with UC. The aim of this study is to determine the clinical significance of a novel optimizing serological biomarker by integrating C-reactive protein (CRP) and bilirubin levels in monitoring disease activity.

Methods: A total of 182 patients with UC were retrospectively enrolled. Clinical characteristics and laboratory parameters of the subjects were retrieved from the electronic medical record database of our hospital. The CRP-to-bilirubin ratio (CBR) was computed for clinical activity of UC defined by the partial Mayo score and endoscopic activity by the Mayo endoscopic score (MES).

Results: CBR was significantly elevated in patients with UC than that in healthy controls. Patients with clinically or endoscopically active UC showed evidently higher CBR levels compared to those with inactive disease, even in a subset of patients with normal CRP levels. Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of CBR was higher than that of CRP or bilirubin alone for determining clinical remission and endoscopic mucosal improvement. Furthermore, CBR levels were significantly decreased when patients achieved mucosal improvement compared with when they had active endoscopic inflammation.

Conclusion: CBR could be useful to reflect disease activity in patients with UC.

Keywords: C-reactive protein; bilirubin; inflammatory bowel disease; mucosal healing; ulcerative colitis.

Grants and funding

This study was financially supported by grants from the National Natural Science Foundation of China (82070985) and the Sichuan Science and Technology Program Grants (2021JDJQ0044).