Intest Res.  2021 Jan;19(1):62-70. 10.5217/ir.2019.09156.

The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis

Affiliations
  • 1Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
  • 2Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea

Abstract

Background/Aims
Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) can serve as biomarkers for diagnosing and assessing disease activity in ulcerative colitis (UC). We investigated their clinical significance in UC.
Methods
We analyzed 48 patients with UC who underwent measurement of fecal calprotectin (FC) and endoscopy and 96 age- and sex-matched healthy controls. NLR and PLR were compared between the patients and healthy controls. The endoscopic activity was divided into 2 groups: group 1 (mild to moderate inflammation) and group 2 (severe inflammation) according to the Mayo endoscopic subscore in UC.
Results
To diagnose UC, the optimal cutoff of NLR and PLR was 2.26 (sensitivity 54.2%; specificity 90.6%; positive likelihood ratio 5.778, 95% confidence interval [CI] 2.944–11.339; area under the curve [AUC] 0.774, 95% CI, 0.690–0.859) and 179.8 (sensitivity 35.4%; specificity 90.6%; positive likelihood ratio 3.778, 95% CI 1.821–7.838; AUC 0.654, 95% CI 0.556–0.753), respectively. The optimal cutoff to differentiate group 1 and group 2 was 3.44, 175.9, and 453 µg/g for NLR, PLR, and FC, respectively (sensitivity, 63.6% vs. 90.9% vs. 81.8%; specificity, 81.1% vs. 78.4% vs. 73.0%; positive likelihood ratio, 3.364 vs. 4.205 vs. 3.027; AUC, 0.714 vs. 0.897 vs. 0.813). PLR had the highest AUC and positive likelihood ratio.
Conclusions
NLR and PLR help differentiate patients with UC from healthy controls. NLR, PLR, and FC indicate endoscopic activity and may reflect intestinal mucosal conditions.

Keyword

Colitis, ulcerative; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio; Fecal calprotectin

Figure

  • Fig. 1. Flowchart of the study subjects. UC, ulcerative colitis.

  • Fig. 2. ROC curve showing the diagnostic performance of NLR, PLR, and FC. (A) In the ROC curve, the optimal cutoff value for NLR and PLR for detecting UC was 2.26 (sensitivity 54.2%; specificity 90.6%; AUC 0.774, 95% CI 0.690–0.859) and 179.8 (sensitivity 35.4%; specificity 90.6%, AUC 0.654, 95% CI 0.556–0.753). (B) The optimal cutoff value for NLR, PLR, and FC for differentiating UC severity were 3.44 (sensitivity 63.6%; specificity 81.1%; AUC 0.714, 95% CI 0.539–0.888), 175.9 (sensitivity 90.9%; specificity 78.4%; AUC 0.897, 95% CI, 0.802–0.992), and 453 μg/g (sensitivity 81.8%; specificity 73.0%; AUC 0.813, 95% CI, 0.655–0.972), respectively. ROC, receiver operator characteristic; NLR, neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; FC, fecal calprotectin; UC, ulcerative colitis; AUC, area under the curve; CI, confidence interval; WBC, white blood cell; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.


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