Use of Platelet-Lymphocyte Ratio and Neutrophil-Lymphocyte Ratio as a Prognostic Marker in IBD
O.Fagan, C. McGrath, H. Logan, V, Madhu, E. Slattery
Gastroenterology, University Hospital Galway
Platelets and PLR have been suggested as a non-invasive biomarker for IBD.
To assess whether neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) predict response in IBD patients with an acute severe flare.
IBD patients admitted with acute severe colitis between January-2017-December-2019 were assessed.
64-patients (88% UC, 9% CD, 3% indeterminate) were included (55% male, 38yo (11-90yrs)). 33% on biologic therapy at admission. 36% received rescue-treatment (95% infliximab, 5% ciclosporin). There was an association between total platelet count (Z-score 9.76, P=<0.05), NLR (Z-score 9.76, p=<0.05)and PLR (Z-score 9.76, P=<0.05) and risk of colectomy. Patients with colectomy-free-survival at 1-year displayed lower NLR and PLR compared with those who did not (6.7 [1.1-33.0] vs 7.5 [1.7-21.00];p=0.39 and 242 [106-1438] vs 259 [155-1300]; p= 0.11). Patients who received rescue-therapy (n=23), had lower week-8 PLR and NLR and persistence of drug at 6-months (p=<0.05). Lower platelet count and PLR at 8-weeks post rescue-therapy was a predictor of persistence of therapy at 6-months (262 [267-469] v 348 [373-558], p=0.01 and 218 [82-521] v 256 [71-630], p=0.34), conversely CRP was not (8 [1-36] v 2.9 [1-6], p=0.23).
Higher platelet count, NLR and PLR on admission with acute severe colitis are associated with progression to colectomy. NLR and PLR should be considered an important prognostic tool in the assessment of acute severe colitis and when elevated should form part of decision making with respect to early escalation of rescue therapy. Platelet count and PLR at 8-weeks post rescue-therapy may also act as a biomarker for prolonged response to therapy.