NEW research into inflammatory bowel disease (IBD) biomarkers found that faecal calprotectin provided the strongest diagnostic performance for distinguishing Crohn’s disease from ulcerative colitis. The findings suggested that non-invasive biomarkers could support assessment of IBD when used alongside standard endoscopic evaluation, while albumin-based scores and simple blood derived inflammatory markers better reflected systemic inflammation than liver fibrosis indices.
The retrospective observational study included 36 adults receiving biological therapy, including 21 patients with Crohn’s disease and 15 patients with ulcerative colitis. Researchers evaluated a range of non-invasive clinical measures, including faecal calprotectin, blood derived inflammatory ratios, nutritional scores incorporating albumin, and liver fibrosis indices. Standardised endoscopic findings were also assessed to determine how well these measures differentiated the two conditions.
Faecal calprotectin concentrations were substantially higher among patients with ulcerative colitis than among patients with Crohn’s disease, with median values of 1000 μg/g and 310 μg/g, respectively. Receiver operating characteristic curve analysis showed that faecal calprotectin demonstrated the greatest diagnostic performance for distinguishing the two diseases (AUC:0.74).
Routine laboratory measures and non-invasive liver fibrosis scores did not differ significantly between the disease groups. However, initiation of biological therapy differed significantly (p<0.001). Endoscopic findings also reflected distinct disease patterns, with Crohn’s disease demonstrating marked phenotypic heterogeneity and predominantly ileocolonic involvement, while active ulcerative colitis most commonly presented as pancolitis.
Among the additional biomarkers assessed, the platelet albumin bilirubin score performed better than traditional liver fibrosis indices (AUC:0.686). The prognostic nutritional index also demonstrated moderate diagnostic performance (AUC:0.657), while the neutrophil lymphocyte ratio achieved an AUC of 0.632. More complex composite inflammatory formulas unexpectedly performed less well than these simpler measures.
The investigators concluded that faecal calprotectin remained the most reliable non-invasive marker for assessing localised mucosal inflammation. Albumin integrating scores and straightforward blood derived inflammatory ratios appeared to capture systemic inflammatory burden more effectively than liver fibrosis indices, although their diagnostic accuracy remained only moderate.
The findings suggested that these biomarkers should not be used independently. Instead, they may provide additional value when interpreted alongside standard endoscopic assessment within a personalised multiparametric approach to IBD management.
Reference
Ismaiel A et al. Crohn᾿s disease and ulcerative colitis: the role of endoscopic, hemogram-derived, nutritional, and hepatic scores. J Gastrointestin Liver Dis. 2026;DOI:10.15403/jgld-7495.
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