Prealbumin and Retinol-Binding Protein 4: The Promising Inflammatory Biomarkers for Identifying Endoscopic Remission in Crohn’s Disease

Abstract

Objective

Endoscopic remission is the primary therapeutic target and associated with clinical outcome in Crohn’s disease (CD). Non-invasive and accurate biomarkers are important in monitoring endoscopic remission frequently. Our study aimed at investigating the predictive capacity of prealbumin and retinol-binding protein 4 (RBP4) for identifying endoscopic remission.

Methods

From June 2018 to December 2020, 515 endoscopy procedures (332 in the training cohort and 183 in the validation cohort) were enrolled in this multicentre retrospective cohort study. Blood samples were collected for prealbumin or RBP4 testing with 7 days before the endoscopy. A simple Endoscopic Score for CD (SES-CD) was performed to evaluate endoscopic activity and defined endoscopic remission. The area under receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value and negative predictive value were performed to assess the predictive capacity of the biomarkers.

Results

Serum concentration of prealbumin and RBP4 was demonstrated to be higher in patients with endoscopic remission and significantly negatively correlated with SES-CD in the training cohort. The AUROC of prealbumin and specificity of prealbumin and RBP4 were larger than that of C-reactive protein in the training cohort and the validation cohort. The model combining prealbumin and faecal calprotectin had the largest AUROC (0.842 [95% CI: 0.775–0.908]). Furthermore, in both cohorts, prealbumin had a larger AUROC than C-reactive protein for identifying endoscopic remission in patients with anti-tumour necrosis factor therapy.

Conclusion

Prealbumin and RBP4 were promising biomarkers for identifying endoscopic remission, especially in patients with anti-tumour necrosis factor therapy.

Keywords:

• Crohn’s disease
• endoscopic remission
• prealbumin
• retinol-binding protein 4

Data Availability

The data supporting the result in this study are available from the corresponding author (Shenghong Zhang, China) on request.

Acknowledgments

This project was supported by grants from the National Natural Science Foundation of China (#81670498, #81870374, #81870384, #81630018, #82000520), Guangzhou Science and Technology Department (#202002030041), Guangdong Science and Technology (#2017A030306021, #2020A1515010249), China Postdoctoral Science Foundation (#2019M653228) and Science and Technology Innovation Young Talents of Guangdong Special Support Plan (#2016TQ03R296). The abstract for this manuscript was presented at a conference named the 21st Congress of Gastroenterology China, 2021 (https://onlinelibrary.wiley.com/doi/10.1111/1751-2980.13053).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The Authors declare that there is no conflict of interest.