Background: Neutrophil-to-lymphocyte ratio (NLR) has been used to determine the outcome in malignancies and coronary heart disease. However, the predictive value of the NLR as a prognostic marker in patients with ulcerative colitis (UC) has not been reported. This study aimed to evaluate the clinical significance of the baseline NLR in patients with UC treated by infliximab.
Methods: Patients with moderate-to-severe active UC who received the first infliximab infusion in our hospital between 2010 and 2015, who showed clinical response during the induction period, were retrospectively evaluated for long-term outcomes and risk factors for loss of response (LOR) during infliximab maintenance therapy. LOR was defined by recurrence of the patients' symptoms during follow-up. Baseline inflammatory markers including NLR were measured within one week before the initiation of infliximab. LOR-free survival was analyzed using the Kaplan-Meier method and Cox regression model.
Results: Fifty-nine patients with moderate-to-severe active UC started treatment with infliximab and 37 patients (62.7%) experienced clinical response after induction therapy. Fourteen of 37 patients on maintenance therapy lost the response during follow-up. Baseline NLR of patients with LOR was significantly higher than in patients with sustained response. The NLR cut-off value of 4.488 was predictive of LOR, using receiver operating characteristic analysis (sensitivity: 78.6%, specificity: 78.3%). A univariate analysis revealed a significant relationship between relapse-free survival and the NLR (p=0.018). Multivariate analysis indicated the NLR as an independent prognostic factor for LOR (hazard ratio =3.86, 95% confidence interval: 1.20–12.4, p=0.023).
Conclusions: Baseline NLR in moderate to severe active UC predicts sustained response to infliximab, and may contribute to appropriate clinical management.