title: Neutrophil-lymphocyte ratio: a controversial marker in predicting Crohn's disease severity.
abstract: Peripheral blood-derived inflammation-based scores such as the neutrophil-lymphocyte ratio (NLR) have recently been proposed as prognostic markers in ulcerative colitis. In some previous serological markers are commonly used to detect the severity of the Crohn's disease (CD), but their sensitivity and specificity are relatively low. So we want to use simple indicators which are easy to obtain to predict disease severity. Now, we investigated and compared the capacity of NLR and other inflammatory markers in detecting CD activity and differentiating CD patients from healthy controls. These CD patients had not received corticosteroid or immunosuppressive drugs within a defined period of time. Data from our hospital between 2010 and 2012 was used. Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cells (WBC), platelet count and albumin were measured in 44 patients with active CD, 66 patients with inactive CD, and 55 healthy blood donors. Disease activity was assessed by the Crohn's Disease Activity Index. In the active CD group, NLR values were found to be elevated compared to inactive CD patients and controls (6.00±7.38, 5.53±6.18 and 1.84±0.85, respectively), but statistical difference was not found between active and inactive CD groups. The overall accuracy of NLR (cutoff: 2.13 fl), CRP (cutoff: 10.5 mg/dl), ESR (cutoff: 19.5 mm/hour) and WBC (cutoff: 9.2 × 10(9)/l) in differentiating CD patients from healthy controls was 80.9%, 67.3%, 71% and 60% respectively. NLR values were found to be correlated with WBC and CRP levels. NLR increased in CD patients compared with healthy subjects. NLR had the best accuracy in determination of CD patients and healthy controls. NLR did not show a discriminative value in disease activity.
authors.affiliation: Departments of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Zhejiang, P. R. China.
authors.forename: Sheng-Qiang
authors.initials: SQ
authors.lastname: Gao
authors.affiliation: Departments of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Zhejiang, P. R. China.
authors.forename: Li-Dong
authors.initials: LD
authors.lastname: Huang
authors.affiliation: Departments of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Zhejiang, P. R. China.
authors.forename: Rui-Jie
authors.initials: RJ
authors.lastname: Dai
authors.affiliation: Departments of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Zhejiang, P. R. China.
authors.forename: Dong-Dong
authors.initials: DD
authors.lastname: Chen
authors.affiliation: Departments of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Zhejiang, P. R. China.
authors.forename: Wei-Jian
authors.initials: WJ
authors.lastname: Hu
authors.affiliation: Departments of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Zhejiang, P. R. China.
authors.forename: Yun-Feng
authors.initials: YF
authors.lastname: Shan
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D003424:Crohn Disease / Q000097:blood* / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count / Q000379:methods; D008214:Lymphocytes; D008297:Male; D009504:Neutrophils; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers
keywords: Crohn’s disease; neutrophil-lymphocyte ratio; noninvasive monitoring
references.citation: Inflamm Bowel Dis. 2004 Sep;10(5):661-5
references.pmid: 15472532
references.citation: Curr Gastroenterol Rep. 2007 Dec;9(6):489-96
references.pmid: 18377802
references.citation: Pancreatology. 2011;11(4):445-52
references.pmid: 21968329
references.citation: Ann Surg. 2009 Jul;250(1):141-51
references.pmid: 19561458
references.citation: Clin Res Hepatol Gastroenterol. 2012 Oct;36(5):491-7
references.pmid: 22841412
references.citation: World J Surg. 2008 Aug;32(8):1757-62
references.pmid: 18340479
references.citation: Inflamm Bowel Dis. 2001 Aug;7(3):192-201
references.pmid: 11515844
references.citation: BMJ. 1989 Jan 14;298(6666):82-6
references.pmid: 2563951
references.citation: N Engl J Med. 2004 Apr 1;350(14):1450-2
references.pmid: 15070796
references.citation: Annu Rev Immunol. 2005;23:197-223
references.pmid: 15771570
references.citation: Am J Gastroenterol. 2008 Jan;103(1):162-9
references.pmid: 17916108
references.citation: Pediatrics. 2007 Jun;119(6):1113-9
references.pmid: 17545378
references.citation: Biomarkers. 2010 Sep;15(6):516-22
references.pmid: 20602543
references.citation: Liver Int. 2012 Feb;32(2):297-302
references.pmid: 22097893
references.citation: Inflamm Bowel Dis. 2002 Sep;8(5):325-9
references.pmid: 12479647
references.citation: Cancer Immunol Immunother. 2009 Jan;58(1):15-23
references.pmid: 18414853
references.citation: Scand J Clin Lab Invest. 2007;67(8):810-20
references.pmid: 18034391
references.citation: Am J Cardiol. 2006 Apr 1;97(7):993-6
references.pmid: 16563903
references.citation: Inflamm Bowel Dis. 2005 Aug;11(8):707-12
references.pmid: 16043984
references.citation: Gastroenterology. 1976 Mar;70(3):439-44
references.pmid: 1248701
references.citation: N Engl J Med. 1987 Dec 24;317(26):1625-9
references.pmid: 3317057
references.citation: Am J Cardiol. 2008 Sep 15;102(6):653-7
references.pmid: 18773982
references.citation: Vasc Endovascular Surg. 2011 Apr;45(3):227-31
references.pmid: 21289130
references.citation: Oncology. 2007;73(3-4):215-20
references.pmid: 18424885
references.citation: Angiology. 2016 Apr;67(4):350-4
references.pmid: 26058674
references.citation: Ann Surg Oncol. 2009 Mar;16(3):614-22
references.pmid: 19130139
references.citation: Inflamm Bowel Dis. 2000 Feb;6(1):8-15
references.pmid: 10701144
references.citation: Clin Rev Allergy Immunol. 2010 Feb;38(1):20-31
references.pmid: 19437144
references.citation: Curr Opin Pediatr. 2008 Oct;20(5):566-70
references.pmid: 18781120
references.citation: Dis Colon Rectum. 2008 Aug;51(8):1283-91
references.pmid: 18543035
references.citation: J Surg Oncol. 2008 May 1;97(6):513-8
references.pmid: 18335453
references.citation: Gut. 1984 Jan;25(1):32-40
references.pmid: 6228498
references.citation: Am Heart J. 2007 Nov;154(5):995-1002
references.pmid: 17967611
references.citation: Neth J Med. 2003 Apr;61(4):105-10
references.pmid: 12852718
references.citation: World J Gastroenterol. 2015 May 14;21(18):5591-7
references.pmid: 25987784
references.citation: J Ophthalmol. 2015;2015:758687
references.pmid: 26060578
references.citation: Eur J Surg Oncol. 2008 Jan;34(1):55-60
references.pmid: 17448623