Serum folic acid, PCT, CRP and ESR detection as biomarker in differentiation ulcerative colitis activity

Abstract Objective: To investigate the serum concentration of folic acid, procalcitonin (PCT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as biomarkers in the differentiation of the severity of ulcerative colitis (UC). Methods: Fifty one patients who had been diagnosed with UC were recruited from January 2014 to August 2017. Twenty-two of these patients had severe diseases while the remaining twenty-nine patients had mild/moderate disease, according to the Truelove-Witts classification criteria. In the same study, 26 healthy subjects which served as the healthy controls were included alongside the UC patient group. The serum folic acid, PCT, CRP and ESR were examined and compared among the healthy control, mild/moderate and severe UC groups. Results: The serum PCT, CRP and ESR in the control group were significantly lower than those of mild/moderate and severe UC groups with statistical significance (p<0.001). However, the serum folic acid in the control group was significant higher than that of mild/ moderate and severe UC groups (p<0.001). The serum folic acid (p=0.015), PCT (p<0.001) and ESR (p<0.001) were significantly different between the severe and mild/moderate groups. However, the serum CRP was not statistically significant between the mild/moderate and severe UC groups (p=0.06). Using serum folic acid, PCT, CRP and ESR as biomarkers in the differentiation of mild/moderate and severe UC, the serum PCT had good diagnostic accuracy for detecting severe UC with the diagnostic sensitivity and specificity of 85.71% (63.66~96.95%), 82.76% (64.23~94.15%), respectively under the cut off value of 0.045. The correlation between serum CRP, ESR and PCT were examined by Pearson correlation test and line regression analysis. However, there was no correlation between each of them with the exception of folic acid and ESR (r=-0.334, p=0.017). Conclusion: Serum folic acid, PCT, CRP and ESR are significantly elevated in patients with active UC thereby presenting novel and potentially promising biomarkers for the diagnosis and differentiation of mild/moderate and sever UC.