Albumin, lymphocyte-to-monocyte ratio tied to tacrolimus response in ulcerative colitis

Concentrations of albumin and the ratio between lymphocyte and monocyte counts can predict failure of tacrolimus treatment in patients with ulcerative colitis, reports a recent study.

The study included 45 patients (mean age 40 years, 77.8 percent men) in whom levels of serum albumin and leukocyte subtypes were measured at tacrolimus induction and at weeks 1 and 2. Treatment failure was defined as requiring colectomy or a switch to biologic or systemic therapy.

Overall, 18 patients failed tacrolimus treatment. There were no baseline differences between those who did and did not fail treatment, though the former group was much older (median, 60.0 vs 36.0 years; p=0.062).

In contrast, serum marker levels showed significant between-group differences at the different time points. Such an effect was reported for serum albumin at week 2. Moreover, the ratio of albumin levels between week 2/week 0 and week 2/week 1 significantly differed between groups.

Receiver operating characteristic curve analysis showed that a low week 2/week 1 ratio of albumin levels was a strong predictor of treatment failure, with an area under the curve (AUC) of 0.815 (95 percent confidence interval [CI], 0.680–0.950) at a cutoff value of 1.06. This had corresponding sensitivity and specificity values of 77.8 percent and 81.5 percent.

Similarly, a low week 1 lymphocyte-to-monocyte ratio was strongly predictive of treatment failure (AUC, 0.815, 95 percent CI, 0.674–0.955; sensitivity: 72.2 percent, specificity: 92.6 percent).

According to the researchers, applying a combination of these markers could provide a more accurate estimation of treatment success in this patient population.