Evaluation of the C-reactive protein/albumin ratio together withendoscopic findings in patients with ulcerative colitis

Evaluation of the C-Reactive Protein/Albumin Ratio Together with Endoscopic Findings in Patients with Ulcerative Colitis Objective: In our study, we aimed to evaluate the C-reactive protein to albumin ratios of patients diagnosed with ulcerative colitis during their clinically active and remission phases together with endoscopic findings, and to investigate the role of this ratio in determining endoscopic and clinical activity. Materials and Methods:In our study, the hospital database records of a total of 455 patients over the age of 18 who were followed up between January 2020 and December 2023 at the Gastroenterology Department and Clinic of Antalya Akdeniz University Hospital were retrospectively reviewed. A total of 63 patients who met the exclusion criteria were excluded from the study. As a result, 392 patients diagnosed with ulcerative colitis based on endoscopic, clinical, and pathological findings were included in the study: 142 patients in the clinically active phase, 58 in clinical remission, and 192 patients who had both active and remission phases documented. The study analyzed patients' age, sex, chronic diseases, medications used for ulcerative colitis (excluding steroids), complete blood count parameters (hemoglobin, neutrophils, lymphocytes, monocytes, platelets), C-reactive protein, albumin, erythrocyte sedimentation rate, extent of ulcerative colitis involvement in colonoscopy, endoscopic Mayo scores, and biopsy results. Results: A total of 209 male patients (53.3%) and 183 female patients (46.7%) were included in the study, with a mean age of 46.65 ± 15.17 years. The mean CRP/Albumin ratio of all patients in the clinically active phase was 6.92, with a median value of 1.6 (IQR: 5.41), whereas in patients in the clinical remission phase, the mean CRP/Albumin ratio was 0.49, with a median value of 0.30 (IQR: 0.41). 70 The CRP/Albumin ratio was found to be significantly higher in patients during the clinically active phase (p < 0.001). Additionally, 192 patients who had been followed during both the clinically active and remission phases were compared within themselves. The mean CRP/Albumin ratio in patients during the clinically active phase was 5.9, with a median value of 1.6 (IQR: 4.5), and this ratio was found to be significantly higher in clinically active patients (p < 0.001). In addition, for identifying clinical activity, a cutoff value of 0.93 was determined, with a sensitivity of 65.6% and a specificity of 87.8%. A positive correlation was found in the correlation analysis conducted between CRP, ESR, and CRP/Albumin values according to the endoscopic Mayo score. In patients with a Mayo score of 2 during the clinically active phase, the area under the curve (AUC) for CRP/Albumin was calculated as 0.627, with a sensitivity of 65.8% and a specificity of 58.4% at a cutoff value of 1.55. In the correlation analysis between the extent of colonic involvement on colonoscopy and inflammatory parameters, a positive correlation was observed for CRP (p < 0.001), ESR (p < 0.001), and CRP/Albumin (p < 0.001). For distinguishing the extent of colonic involvement based on colonoscopy, the AUC for CRP/Albumin at a cutoff value of 0.85 was found to be 0.685, with a sensitivity of 66.7% and a specificity of 60.4%. A statistically significant difference was also observed between the Montreal classification of endoscopic extent and the endoscopic Mayo score. Conclusion: A positive correlation was found between the CRP/Albumin ratio and clinical activity, endoscopic activity, and the extent of endoscopic involvement. The CRP/Albumin ratio is a simple, inexpensive, and easily calculable parameter that can be used in patients with ulcerative colitis. However, further multicenter, prospectively designed studies are needed to support its broader use in clinical practice. Keywords: Ulcerative colitis, CRP, Albumin, CRP/Albumin ratio, Disease activity, Endoscopic activity