Crohn᾿s Disease and Ulcerative Colitis: The Role of Endoscopic, Hemogram-derived, Nutritional, and Hepatic Scores

Abstract

Background and Aims: Inflammatory bowel disease (IBD) requires reliable non-invasive biomarkers to monitor mucosal healing, systemic inflammation, and gut-liver axis involvement. This study evaluated the diagnostic potential of accessible clinical parameters, including fecal calprotectin (FC), hemogram-derived ratios, and composite albumin-integrating and liver fibrosis scores, alongside standardized endoscopic severity findings.

Methods: This retrospective observational study included 36 adult IBD patients [21 with Crohn’s disease (CD), 15 with ulcerative colitis (UC) receiving biological therapy. Systemic inflammatory indices [e.g., neutrophil-lymphocyte ratio (NLR)], nutritional scores [e.g. prognostic nutritional index (PNI)], and hepatic fibrosis scores [e.g. aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 (FIB-4), platelet-albumin-bilirubin (PALBI)] were assessed. Receiver operating characteristic (ROC) curve analysis evaluated the diagnostic performance, reported as area under the curve (AUC), of these biomarkers.

Results: Routine laboratory parameters and non-invasive liver fibrosis indices showed no statistically significant differences between CD and UC patients. Biologic treatment initiation differed significantly between the groups (p<0.001). Endoscopically, CD presented marked phenotypic heterogeneity with predominantly ileocolonic involvement, whereas active UC was characterized mainly by pancolitis. Fecal calprotectin concentrations were notably higher in UC (median 1000 μg/g) compared to CD (310 μg/g). Diagnostically, FC demonstrated the highest predictive capacity for differentiating the conditions (AUC=0.74). Furthermore, albumin-integrating scores, specifically the PALBI score (AUC = 0.686) and PNI (AUC = 0.657), alongside NLR (AUC=0.632), outperformed traditional hepatic indices in capturing the systemic inflammatory toll. Complex composite inflammatory formulas unexpectedly underperformed.

Conclusions: FC remains the most robust non-invasive marker for localized mucosal inflammation. Albumin-integrating scores and simple hemogram-derived ratios better reflect the systemic inflammatory burden than pure hepatic fibrosis indices, but their moderate diagnostic accuracies preclude independent clinical application. Effective IBD management requires integrating these non-invasive adjunctive tools with standard endoscopic assessments within a personalized, multiparametric framework.