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Neutrophil-to-Lymphocyte Ratio: An Easy Marker for the Diagnosis and Monitoring of Inflammatory Bowel Disease in Children

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Abstract

Background

The neutrophil-to-lymphocyte ratio (NLR) is a simple and inexpensive inflammation biomarker that reflects systemic inflammation based on complete blood count values.

Aims

In our study, we aimed to compare the NLR values in pediatric inflammatory bowel disease (IBD) and in healthy controls, and to define NLR levels in children with IBD during diagnosis, active disease, and remission.

Methods

NLR values of patients with IBD at diagnosis, remission, and active disease of the patients were recorded retrospectively. Age- and sex-matched healthy subjects enrolled as the control group.

Results

Sixty-three patients with IBD and 92 healthy subjects as the control group enrolled. The mean age of the patients with IBD was 9.31 ± 5.24 years, and 57.1% were males. The mean NLR values of the patients with IBD at diagnosis and remission were significantly higher than that of healthy controls (p < 0.001). The mean NLR values of the patients at diagnosis and active disease were significantly higher than that of during remission (p < 0.001). The best cutoff of NLR for prediction of diagnosis of IBD in children was 1.46 with a sensitivity of 86.2% and specificity of 93.5%. There was no significant difference regarding NLR between patients with IBD with and without associated diseases. At diagnosis the mean NLR level of patients with Crohn's disease was significantly higher than that of ulcerative colitis (p = 0.019).

Conclusions

It was shown for the first time that NLR levels were significantly increased at diagnosis and active disease of childhood IBD, compared to the remission period. We believe that NLR can be a non-invasive inflammatory biomarker that should be used in the initial evaluation and follow-up of the disease activity in children.

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Abbreviations

anti-TNF:

Anti-tumor necrosis factor-α

CVID:

Common variable immunodeficiency

CRP:

C-reactive protein

CD:

Crohn’s disease

ESR:

Erythrocyte sedimentation rate

FMF:

Familial Mediterranean Fever

FC:

Fecal calprotectin

IBD:

Inflammatory bowel diseases

LRBA:

LPS-responsive beige-like anchor protein

NVDW:

Neutrophil volume distribution width values

PCDAI:

Pediatric crohn’s disease activity ındex

PUCAI:

Pediatric ulcerative colitis activity ındex

ROC:

Receiver operating characteristic

UC:

Ulcerative colitis

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Funding

Pınar Şimşek-Onat has no relevant financial disclosures. Hayriye Hizarcioglu-Gulsen has no relevant financial disclosures. Yasin Maruf Ergen has no relevant financial disclosures. Ersin Gumus has no relevant financial disclosures. Hasan Özen has no relevant financial disclosures. Hülya Demir has no relevant financial disclosures. Seza Özen has no relevant financial disclosures. İnci Nur Saltık-Temizel has no relevant financial disclosures.

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children’s Hospital, Hacettepe University, Ankara, Turkey

    Pınar Şimşek-Onat, Hayriye Hizarcioglu-Gulsen, Yasin Maruf Ergen, Ersin Gumus, Hasan Özen, Hülya Demir & İnci Nur Saltık-Temizel

  2. Division of Pediatric Rheumatology, Faculty of Medicine, Ihsan Dogramaci Children’s Hospital, Hacettepe University, Ankara, Turkey

    Seza Özen

Authors
  1. Pınar Şimşek-Onat
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  2. Hayriye Hizarcioglu-Gulsen
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  3. Yasin Maruf Ergen
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  6. Hülya Demir
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  8. İnci Nur Saltık-Temizel
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Contributions

PŞ-O: Made substantial contributions to the conception, design, acquisition, analysis, and interpretation of data, drafted the work, approved the final version, agreed to be accountable for all aspects of the work. HH-G: Made substantial contributions to the conception, design, interpretation of data, revised the work, approved the final version, agreed to be accountable for all aspects of the work. YME: Made substantial contributions to the conception, design, interpretation of data, approved the final version, agreed to be accountable for all aspects of the work. EG: Made substantial contributions to the conception, design, interpretation of data, approved the final version, agreed to be accountable for all aspects of the work. HÖ: Made substantial contributions to the conception, design, acquisition, analysis, and interpretation of data, revised the work, approved the final version, agreed to be accountable for all aspects of the work. HD: Made substantial contributions to the conception, design, interpretation of data, revised the work, approved the final version, agreed to be accountable for all aspects of the work. SÖ: Made substantial contributions to the conception, design, interpretation of data, revised the work, approved the final version, agreed to be accountable for all aspects of the work. İNS-T: Made substantial contributions to the conception, design, acquisition, analysis, and interpretation of data, revised the work, approved the final version, agreed to be accountable for all aspects of the work.

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Correspondence to Pınar Şimşek-Onat.

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Şimşek-Onat, P., Hizarcioglu-Gulsen, H., Ergen, Y.M. et al. Neutrophil-to-Lymphocyte Ratio: An Easy Marker for the Diagnosis and Monitoring of Inflammatory Bowel Disease in Children. Dig Dis Sci 68, 233–239 (2023). https://doi.org/10.1007/s10620-022-07547-z

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