Clin Transl Gastroenterol. 2025 Jan 21. doi: 10.14309/ctg.0000000000000824.Online ahead of print.

Bishoi Aziz ¹, Reza Belaghi ², Hien Huynh ¹, Kevan Jacobson ³, David R Mack ², Colette Deslandres ⁴, Anthony Otley ⁵, Jennifer DeBruyn ⁶, Wael El-Matary ⁷, Eileen Crowley ^8 9, Mary Sherlock ¹⁰, Jeffery Critch ¹¹, Najma Ahmed ¹², Anne Griffiths ¹³, Thomas Walters ¹³, Eytan Wine ^1 14; Canadian Children IBD Network

Author information

¹Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

²Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.

³Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.

⁴Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.

⁵Departement of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.

⁶Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.

⁷Department of Pediatrics, University of Manitoba, Winnipeg, Canada.

⁸Department of Pediatrics, Division of Pediatric Gastroenterology, Children's Hospital Western Ontario, Western University, London, Ontario, Canada.

⁹Health Sciences Centre, London, Ontario, Canada.

¹⁰Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

¹¹Department of Pediatrics, Memorial University, St. John's, Newfoundland and Labrador, Canada.

¹²Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.

¹³Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

¹⁴Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) is a novel biomarker studied in several autoimmune diseases including inflammatory bowel diseases (IBD) in adults, but poorly characterized in pediatric IBD (pIBD). We aimed to primarily investigate the relationship between NLR and pIBD endoscopic disease severity. We also examined whether NLR predicted hospitalization, surgery, and therapy response by 52 weeks.

Methods: We used the Canadian children IBD Network (CIDsCaNN) prospective inception cohort including patients<18 years old with baseline data from 2013-2022. We excluded patients with concurrent diseases affecting NLR. Both Mayo endoscopic score (MES) and simple endoscopic scale for Crohn Diseases (SES-CD) were dichotomized as low (quiescent-mild), and high activity (moderate-severe). For therapy responses, we examined year-1 steroid- and biologic-free remission. We used logistic regression for binary outcomes.

Results: 580 UC and 1081 CD patients were included. High NLR was associated with high activity MES and SES-CD in both univariate and multivariable analyses (OR=1.45, 95%CI= 1.07-1.97, p-value=0.016; and OR=1.42, 95%CI= 1.04-1.94, p-value=0.026, respectively). We also calculated the best NLR cutoff point to predict MES (1.90, sensitivity=68%, specificity=67%, AUC=0.67, AUC 95%CI= 0.59-0.74) and SES-CD (2.50, sensitivity=63%, specificity=69%, AUC=0.66, AUC 95%CI= 0.59-0.75) high activity. NLR did not predict therapy response in either UC or CD.

Conclusion: pIBD patients with high baseline NLR are more probable to have worse endoscopic disease at diagnosis. This highlights NLR potential as a reliable non-invasive biomarker of disease activity. The predictive power of NLR is based mostly on neutrophils and the balance between neutrophils and lymphocytes.