Lymphocyte to monocyte ratio and serum albumin changes predict tacrolimus therapy outcomes in patients with ulcerative colitis

Abstract

Tacrolimus therapy for ulcerative colitis is ineffective in certain patients; these patients require biologics or colectomy. We examined the ability of serum albumin levels and leukocyte subtypes to predict the therapeutic efficacy of tacrolimus. Patients with ulcerative colitis treated with tacrolimus were divided into non-failure and failure (required colectomy or switch to biologics or systemic steroids) groups. Serum albumin levels and leukocyte subtypes at induction, week 1, and week 2 after reaching high trough levels were retrospectively examined. Tacrolimus therapy failed in 18/45 patients within 3 months. The week 2/week 1 albumin ratio was significantly different between the failure and non-failure groups (P < 0.001). The receiver operating characteristic curve analysis revealed optimal cut-off value of the week 2/week 1 albumin ratio was 1.06, and area under the curve was 0.815. Analysis of leukocyte subtypes revealed significant between-group difference in the week 1 lymphocyte to monocyte ratio (P < 0.001). Multivariate analysis showed week 2/week 1 albumin ratio ≤ 1.06 and week 1 lymphocyte to monocyte ratio ≤ 3.86. Therefore, a low week 2/week 1 albumin and low week 1 lymphocyte to monocyte ratio predicted failure within 3 months of tacrolimus induction; a combination of these markers could accurately predict failure.

Figure 1

Kaplan–Meier time-to-relapse curve of patients with ulcerative colitis (UC) in relation to the week 2 (W2)/week 1 (W1) albumin (Alb) ratios > 1.06 and ≤ 1.06.

Figure 2

Kaplan–Meier time-to-relapse curve of patients with ulcerative colitis (UC) in relation to the leukocyte to monocyte (L/M) ratios > 3.86 and ≤ 3.86.

Figure 3

Kaplan–Meier time-to-relapse curve of patients with ulcerative colitis (UC) by group: the week 2 (W2)/week 1 (W1) albumin (Alb) ratio > 1.06 and leukocyte to monocyte (L/M) ratio > 3.86 group, the W2/W1 Alb ratio ≤ 1.06 and L/M ratio at W1 ≤ 3.86 group, and other groups (W2/W1 Alb ratio > 1.06 and L/M ratio at W1 ≤ 3.86 or W2/W1 Alb ratio ≤ 1.06 and L/M ratio at W1 > 3.86).