P138 Platelet-to-lymphocyte ratio index: a reliable tool for non-invasive assessment of endoscopic activity in small bowel Crohn’s Disease

Abstract Background The platelet-to-lymphocyte ratio (PLR) index has been a recent focus of investigation as a reliable marker of inflammation. This score was recently shown to have a good accuracy upon predicting endoscopic remission in patients with colonic Crohn’s Disease (CD). We aimed to assess the discriminative power of PLR index in patients with isolated small bowel CD. Methods Single center study of consecutive patients with isolated small bowel CD (L1 ± L4 disease according to Montreal classification) who underwent small bowel capsule endoscopy (SBCE) for assessment of endoscopic activity between January 2019 and December 2020. Only complete SBCEs were considered. CD endoscopic activity was classified according to the Lewis score (LS) value. Complete blood count, C-reactive protein and fecal calprotectin values were collected within 1 month of SBCE. Results Final sample included 49 patients, 35 (71.4%) of them females, with a mean age of 35.1±11.8 years. SBCE reported mucosal healing (LS<135) in 30.6% of the patients; mild activity (135≤LS<790) in 42.9% and moderate-to-severe activity (LS≥790) in 26.5% of the patients. PLR index positive correlation with LS was significant and moderate (k=0.597; p<0.001). This correlation was stronger than the one seen between fecal calprotectin (k=0.525; p=0.001) or C-reactive protein (k=0.321; p=0.029) and the LS score. In particular, PLR index presented an excellent accuracy for predicting patients with a moderate-to-severe endoscopic activity (AUC=0.908; 95%CI=0.816–0.999; p<0.001), with an optimal cut-off of PLR above 157 (sensitivity 92.3%; specificity 82.9%). The accuracy for prediction of mucosal healing was good (AUC=0.743; 95%CI=0.600–0.887; p=0.007), with an optimal cut-off of PLR below 126 (sensitivity 66.7%; specificity 80.0%). Conclusion PLR index demonstrated an excellent acuity for predicting patients with moderate to severe disease in small bowel CD. Moreover, it also demonstrated good acuity for predicting mucosal healing on this set of patients. These results come from a significant correlation of PLR index with endoscopic activity in small bowel CD. Our findings establish this index as a promising and easy-to-apply tool for non-invasive and regular follow-up of patients with small bowel CD.

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Capsule endoscopic findings correlate with fecal calprotectin and C-reactive protein in patients with suspected small-bowel Crohn’s disease

Scandinavian Journal of Gastroenterology ◽

10.3109/00365521.2014.920915 ◽

2014 ◽

Vol 49 (9) ◽

pp. 1084-1090 ◽

Cited By ~ 31

Author(s):

Charlotte M. Höög ◽

Lars-Åke Bark ◽

Olle Broström ◽

Urban Sjöqvist

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Fecal Calprotectin ◽

C Reactive Protein ◽

Reactive Protein ◽

Endoscopic Findings

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Su1934 A DIRECT COMPARISON OF FECAL CALPROTECTIN, HIGH-SENSITIVITY C-REACTIVE PROTEIN, AND LEUCIN-RICH ALPHA-2 GLYCOPROTEIN IN DETECTING ACTIVITY OF SMALL BOWEL CROHN'S DISEASE

Gastroenterology ◽

10.1016/s0016-5085(20)32460-4 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-708-S-709

Author(s):

Kunio Asonuma ◽

Shintaro Sagami ◽

Hiroki Kiyohara ◽

Mao Matsubayashi ◽

Hiromu Morikubo ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

High Sensitivity ◽

Fecal Calprotectin ◽

C Reactive Protein ◽

Reactive Protein

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Combined evaluation of fecal calprotectin and C-reactive protein as a therapeutic target in the management of patients with Crohn's disease

Gastroenterología y Hepatología (English Edition) ◽

10.1016/j.gastre.2020.04.010 ◽

2021 ◽

Vol 44 (2) ◽

pp. 87-95

Author(s):

Francisco Guilherme Cancela Penna ◽

Rodrigo Macedo Rosa ◽

Fernando H. Pereira ◽

Pedro Ferrari Sales Cunha ◽

Stella Cristina S. Sousa ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Therapeutic Target ◽

Fecal Calprotectin ◽

C Reactive Protein ◽

Reactive Protein ◽

Combined Evaluation

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Panenteric capsule endoscopy identifies proximal small bowel disease guiding upstaging and treatment intensification in Crohn’s disease: A European multicentre observational cohort study

United European Gastroenterology Journal ◽

10.1177/2050640620948664 ◽

2020 ◽

pp. 205064062094866 ◽

Cited By ~ 1

Author(s):

Foong Way D Tai ◽

Pierre Ellul ◽

Alfonso Elosua ◽

Ignacio Fernandez-Urien ◽

Gian E Tontini ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Bowel Disease ◽

Mucosal Healing ◽

Small Bowel Disease ◽

Treatment Intensification ◽

Non Invasive ◽

Proximal Small Bowel

Background Endoscopically defined mucosal healing in Crohn’s disease is associated with improved outcomes. Panenteric capsule endoscopy enables a single non-invasive assessment of small and large bowel mucosal inflammation. Aims and methods: This multicentre observational study of patients with suspected and established Crohn’s disease examined the feasibility, safety and impact on patient outcomes of panenteric capsule endoscopy in routine clinical practice. The potential role in assessment of disease severity and extent by a comparison with existing clinical and biochemical markers is examined. Results Panenteric capsule endoscopy was performed on 93 patients (71 with established and 22 with suspected Crohn’s disease). A complete examination occurred in 85% (79/93). Two cases (2.8%) of capsule retention occurred in patients with established Crohn’s disease. Panenteric capsule resulted in management change in 38.7% (36/93) patients, including 64.6% (32/48) of those with an established diagnosis whose disease was active, and all three patients with newly diagnosed Crohn’s disease. Montreal classification was upstaged in 33.8% of patients with established Crohn’s disease and mucosal healing was demonstrated in 15.5%. Proximal small bowel disease upstaged disease in 12.7% and predicted escalation of therapy (odds ratio 40.3, 95% confidence interval 3.6–450.2). Raised C-reactive protein and faecal calprotectin were poorly sensitive in detecting active disease (0.48 and 0.59 respectively). Conclusions Panenteric capsule endoscopy was feasible in routine practice and the ability to detect proximal small bowel disease may allow better estimation of prognosis and guide treatment intensification. Panenteric capsule endoscopy may be a suitable non-invasive endoscopic investigation in determining disease activity and supporting management decisions.

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Predictors of efficacy, mucosal healing and dose intensification during the first year of adalimumab therapy in patients with luminal and fistulizing Crohn’s disease. National data from Hungary

Orvosi Hetilap ◽

10.1556/oh.2011.29200 ◽

2011 ◽

Vol 152 (36) ◽

pp. 1433-1442 ◽

Cited By ~ 1

Author(s):

Lajos Sándor Kiss ◽

Tamás Szamosi ◽

Tamás Molnár ◽

Pál Miheller ◽

László Lakatos ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Clinical Efficacy ◽

Mucosal Healing ◽

C Reactive Protein ◽

Medium Term ◽

Dose Intensification ◽

Azathioprine Therapy ◽

Reactive Protein ◽

Adalimumab Therapy

Adalimumab is a fully human monoclonal antibody targeting tumor necrosis factor with proven efficacy in the treatment of Crohn’s disease in clinical trials. The aim of the present study was to investigate the predictors of medium term clinical efficacy and mucosal healing during adalimumab therapy in patients with Crohn’s disease in specialized centers approved for biological therapy in Hungary. Methods: Data of 201 Crohn’s disease patients were prospectively captured (male/female: 112/89, median age: 24 years, duration: 8 years). Previous infliximab therapy was given in 97 (48.3%) patients, concomitant steroids in 41.3% and azathioprine in 69.2% (combined: 26.4%) of patients. Results: Overall clinical response and remission rates at 24 and 52 weeks were 78% and 52%, and 69.4% and 44.4%, respectively. Endoscopic improvement and healing was achieved in 43.1% and 23.6%, respectively. In a logistic regression model, clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, while normalized C-reactive protein at week 12, clinical remission at week 24, frequency of previous relapses and smoking were associated to endoscopic improvement/healing. Dose intensification to weekly dosing was needed in 16.4%. Parallel azathioprine therapy and clinical remission at week 12 was inversely associated to dose escalation to weekly dosing. Conclusion: Clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression, luminal disease and smoking are predictors for medium term clinical efficacy/mucosal healing during adalimumab therapy, while parallel azathioprine therapy may decrease the probability for dose escalation. Orv. Hetil., 2011, 152, 1433–1442.

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