From blood to bowel: correlating serological markers with mucosal healing and inflammation in patients with inflammatory bowel disease

Abstract

Background Inflammatory bowel disease (IBD) is a systemic disease characterized by chronic inflammation of the gastrointestinal tract. Serological testing has the advantages of wide sources and easy detection. Objective To explore the correlation between the serological markers and endoscopic mucosal healing and histological healing. We also explored the predictive value of individual and combined detection on the disease activity of ulcerative colitis (UC) and Crohn’s disease (CD) and provide reference for clinical non-invasive evaluation. Methods We retrospectively analyzed 267 IBD patients treated at our hospital from May 2020 to June 2024. Patients were classified based on endoscopic, pathological, or imaging results into UC (141 patients) and CD (126 patients). UC patients were further divided into mucosal healing (32 cases, IMES ≤ 1), mild (41 cases, 3 ≤ IMES ≤ 5), moderate (49 cases, 6 ≤ IMES ≤ 10), and severe (19 cases, 11 ≤ IMES ≤ 12) phases by the Improved Mayo Endoscopic Score (IMES). CD patients were categorized by the Crohn’s Disease Activity Index (CDAI). According to the Geboes score, patients were divided into a histological healing group (n=63) and a histological activity group (n=204). Pearson analysis examined correlations and ROC analysis assessed their predictive value. Results In severe cases, ALB and PA were lower, and CRP, ESR, NLR, and PLR were higher than in moderate cases (P<0.05). The serum ALB and PA levels in the histological activity group were lower, but CRP, ESR, NLR, and PLR were higher than the histological healing group (all P<0.05). Pearson analysis revealed negative correlations between IMES/CDAI scores and ALB/PA levels, and positive correlations with CRP, ESR, NLR, and PLR levels (P<0.05). The combined detection of serological indicators for predicting UC inflammatory activity had an AUC of 0.930, with 88.89% sensitivity and 89.47% specificity, outperforming individual indicators (Z-values all P<0.05). For CD, the combined AUC was 0.906, with 86.75% sensitivity and 85.71% specificity, again surpassing single indicators (Z-values all P<0.05). Conclusion Differences in serum ALB, PA, CRP, ESR, NLR, PLR were correlated with mucosal healing and inflammation in IBD patients. Combined detection offers clinical value in predicting disease activity.