Abstract Background Recent guidelines emphasize the importance of dynamic monitoring of objective inflammatory parameters rather than relying solely on clinical indices (1, 2). Biomarkers such as C-reactive protein (CRP), serum albumin, and derived ratios including the CRP/albumin ratio (CAR) and the neutrophil-to-lymphocyte ratio (NLR) have gained increasing attention for their prognostic value in inflammatory bowel disease (3-5). CAR, in particular, integrates systemic inflammation and nutritional status and has been associated with poor outcomes in hospitalized UC cohorts (6-8). However, evidence validating these biomarkers in biologic-naïve, first-episode ASUC patients remains scarce, and their role in predicting early steroid response under real-world conditions has not been clearly defined (9,10). Therefore, this study aimed to evaluate short-term intravenous steroid therapy (IVS) response rates and to investigate the prognostic utility of CRP, albumin, CAR, and NLR in predicting early (day 3) and late (day 7) steroid responsiveness in a real-world Turkish ASUC cohort. Methods We retrospectively analyzed biologic-naïve adult patients hospitalized with a first ASUC episode (Truelove–Witts criteria) between 2010 and 2023. IVS nonresponse was defined by Oxford criteria at day 3; partial/nonresponders continuing IVS were reassessed at day 7. Two multivariable logistic regression models were built separately for day 3 and day 7: Model A (CRP, albumin, neutrophil and lymphocyte counts) and Model B (CAR and NLR). ROC analysis quantified the diagnostic performance of CAR at both time points. Results Ninety-eight patients were included (62.2% male, predominant left-sided disease). IVS response rates were 11.2% at day 3 and 56.1% at day 7. Model A: No independent predictors at day 3; at day 7, albumin independently predicted response (OR 10.92, 95% CI 1.57–76.24, p = 0.016). Model B: CAR showed a non-significant negative trend at day 3; at day 7, CAR independently and negatively predicted response (OR 0.29, 95% CI 0.09–0.94, p = 0.040). CAR demonstrated good discrimination (AUC 0.755 at day 3; AUC 0.713 at day 7) with optimal cut-offs around 0.56 and 1.33, respectively. Conclusion In this real-world ASUC cohort, day-7 albumin and CAR may provide practical, dynamic indicators of shortterm IVS response. Monitoring the trajectories of albumin and CAR up to day 7 could support risk stratification and the timing of rescue therapy. Prospective, multicenter studies are warranted to validate these findings. References: 1. Magro F, et al. ECCO Guidelines on Ulcerative Colitis: Medical Treatment. J Crohns Colitis. 2023;17(3):369-405. 2. Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: An update on the Selecting Therapeutic Targets in IBD initiative of the IOIBD. Gastroenterology. 2021;160(5):1570-1583. 3. Lee SH, Kim MJ, Chang DK. Prognostic value of the CRP-to-albumin ratio in ulcerative colitis. J Clin Med. 2020;9(1):72. 4. Celikbilek M, Dogan S, Ozbakir O, et al. Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis. Int J Clin Exp Med. 2014;7(12):5583-5588. 5.Ishida S, Yokoyama Y, Seki Y, et al. C-reactive protein/albumin ratio as a predictor of treatment response and long-term outcome in ulcerative colitis. Dig Dis Sci. 2021;66(1):297-305. 5. Kuno T, Tanimoto M, Hashimoto S, et al. CRP/albumin ratio as a prognostic marker in ulcerative colitis requiring hospitalization. Dig Dis Sci. 2020;65(1):132-139. 6. Hanai H, Iida T, Takeuchi K, et al. Relationship between serum albumin level and disease activity in ulcerative colitis. World J Gastroenterol. 2011;17(3):271-275. 7. Seo M, Okada M, Yao T, et al. Serum albumin as a prognostic factor in patients with ulcerative colitis. Scand J Gastroenterol. 1996;31(4):356-360. 8. Gibson DJ, Hartery K, Doherty J, et al. CRP/albumin ratio: an early predictor of steroid responsiveness in acute severe ulcerative colitis. J Clin Gastroenterol. 2018;52(6):e48-52. 9. Yamamoto T, Shimoyama T, Umegae S, Matsumoto K. Long-term outcomes of ulcerative colitis: a cohort study of 343 patients. World J Gastroenterol. 2006;12(32):5178-5181. Conflict of interest: Mr. Sayar, Suleyman: No conflict of interest Aykut, Hüseyin: No conflict of interest Pala, Emin: No conflict of interest
Sayar et al. (Thu,) studied this question.