Risk prediction of inflammatory bowel diseases in the patients lacking the laboratory inflammation markers

Some patients with inflammatory bowel disease (IBD) may lack the conventional inflammation criteria, i.e., elevated CRP, ESR and leukocytosis. The aim of this study was to search for additional laboratory risk criteria of IBD in patients with non-specific inflammation markers. The study involved 150 patients divided in two groups: an observation group (100 patients with a verified diagnosis of ulcerative colitis or Crohn’s disease) and a control group (50 clinically healthy individuals). All subjects were tested for complete blood analysis, blood biochemistry. IL-1β, TNFα, and IL-4 concentrations were also assayed. As based on general blood counts and biochemistry testing, the patients from the observation group were divided in two subgroups, i.e., the persons with classic laboratory signs of inflammation, and those without detectable inflammation markers. Three main laboratory blood parameters were assessed for diagnostics of inflammatory process: ESR, white blood cell counts and CRP level. Increase in two or more of the above blood parameters had been considered a positive finding. It was noted that 40% of patients with IBD lacked the non-specific laboratory criteria of inflammation: in 37% of patients with ulcerative colitis, and in 46% of Crohn’s disease cases (p < 0.001). Moreover, we carried out a comparative analysis of cytokine levels and biochemical markers in the blood serum from the controls, and IBD patients without laboratory signs of inflammation. Based on the obtained data, we developed a prognostic model for the IBD probability in patients without non-specific inflammation markers, depending on biochemical and immunological blood parameters. The model included such serum parameters as glucose, sodium and IL-4 concentrations. The predictive ability of the model was assessed using ROC analysis (AUC 0.970±0.018 95% CI: 0.936-1.000; p < 0.001). An algorithm for predicting the IBD risk in patients without non-specific laboratory criteria of inflammation was proposed. The obtained data enable us to identify additional criteria for the IBD risk in patients lacking the non-specific metabolic criteria of inflammation.