Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 334-343
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.334
Effective immune-inflammation index for ulcerative colitis and activity assessments
Meng-Hui Zhang, Han Wang, Hong-Gang Wang, Xin Wen, Xiao-Zhong Yang
Meng-Hui Zhang, Han Wang, Hong-Gang Wang, Xin Wen, Xiao-Zhong Yang, Department of Gastroenterology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai’an 223300, Jiangsu Province, China
Author contributions: Zhang MH and Wang H contributed equally to this work by participating in project design, data collection, literature retrieval, data collection and analysis, and drafting of the article; All authors have approved the final version of the manuscript.
Institutional review board statement: The study was approved by the medical ethics committee of The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University Institutional.
Conflict-of-interest statement: All of the authors declare that they have no conflicts of interest regarding this paper.
Data sharing statement: No additional unpublished data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xiao-Zhong Yang, MD, PhD, Associate Professor, Doctor, Department of Gastroenterology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huai’an 223300, Jiangsu Province, China.
Received: July 4, 2020
Peer-review started: July 4, 2020
First decision: September 14, 2020
Revised: September 28, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: January 16, 2021

The inverse association between systemic immune-inflammation index (SII) and overall survival in tumors has been studied.


To evaluate the hematological indexes for assessing the activity of ulcerative colitis (UC).


In this case-control study, 172 UC patients and healthy participants were included. Comparisons were made among groups of white blood cells, hemoglobin, platelets, neutrophils, lymphocytes, monocytes, SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). The relationship with hematological inflammation was verified by Spearman correlation analyses. The efficiency of SII, NLR, and PLR for distinguishing between UC and severe disease status was assessed by the receiver operator curve and logistic regression analyses.


The values of SII, NLR, and PLR were higher in UC patients than in controls (P < 0.001) and were positively correlated with the Mayo endoscopic score, extent, Degree of Ulcerative Colitis Burden of Luminal Inflammation (DUBLIN) score, and Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The cut-off NLR value of 562.22 predicted UC with a sensitivity of 79.65% and a specificity of 76.16%. Logistic regression analysis revealed that patients with SII and NLR levels above the median had a significantly higher risk of UC (P < 0.05). Risk factors independently associated with DUBLIN ≥ 3 included SII ≥ 1776.80 [odds ratio (OR) = 11.53, P = 0.027] and NLR value of 2.67-4.23 (OR = 2.96, P = 0.047) on multivariate analysis. Compared with the first quartile, SII ≥ 1776.80 was an independent predictor of UCEIS ≥ 5 (OR = 18.46, P = 0.012).


SII has a certain value in confirming UC and identifying its activity.

Keywords: Ulcerative colitis, Systemic immune-inflammation index, Endoscopic score, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Disease activity

Core Tip: Although endoscopy examination is the standard for assessing ulcerative colitis (UC) relapse, it is invasive, intolerable, and weakly repeatable. Non-invasive parameters can be used to assess the disease activity of UC. However, the value of routine blood testing for predicting UC severity has not been studied in depth. This study evaluated the differential leucocytic ratio, such as systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio, to provide easy and reliable methods for disease activity.