{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:56:19Z","timestamp":1789167379556,"version":"build-2803163510"},"reference-count":33,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,29]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Disease activity assessment is important for Crohn\u2019s disease (CD) management, since it involves the initial and subsequent therapeutic schedule. The purpose of this study is to identify a portable and reliable indicator for assessing and predicting activity and severity of CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multicentre, cross-sectional, diagnosis-based study. Data were obtained retrospectively from clinical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Patient data for the development cohort and internal validation cohort were collected from the Department of Gastroenterology, Xiangya Hospital, Central South University between January 2017 and June 2021. Patient data for the external validation cohort were collected from the Department of Gastroenterology, Xiangtan Central Hospital between January 2022 and April 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Inpatients diagnosed with CD were potential participants, and those with CD who also had other autoimmune diseases, malignant tumours, pregnancy or lactation were excluded. We identified 224 patients in the development cohort, 96 patients in the internal validation cohort and 80 patients in the external validation cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measure<\/jats:title>\n                    <jats:p>\n                      Demographic data and laboratory examination results were collected and seven integrated indices were established. Mann-Whitney U test, Kruskal-Wallis K test, \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test and multivariate logistic regression analysis were used to identify independent predictors. Receiver operating characteristics curve analysis was used to evaluate the performance of integrated indices in CD activity and severity staging, and Delong\u2019s test was used for comparison.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the development cohort, platelet-to-albumin ratio (PAR) had the largest area under the curve (AUC) in prediction of activity (AUC of 0.753 (0.687\u20130.819), sensitivity 73.0%, specificity 68.4%, cut-off value 8.02) and was the only possible alternative in prediction of severity (AUC of 0.770 (0.693\u20130.848), sensitivity 81.2%, specificity 68.4%, cut-off value 9.71). Moreover, PAR demonstrated coherence in the internal validation cohort, effectively predicting activity (AUC 0.737 (0.639\u20130.835), sensitivity 65.7%, specificity 79.3%, positive predictive value (PPV) 88.0%, negative predictive value (NPV) 50.0%) and severity (AUC 0.720 (0.591\u20130.848), sensitivity 88.5%, specificity 77.4%, PPV 76.7%, NPV 64.9%). Furthermore, it showed generalisability in the external validation cohort for predicting activity (AUC 0.661 (0.536\u20130.785), sensitivity 61.9%, specificity 70.6%, PPV 88.6%, NPV 33.3%) and severity (AUC 0.752 (0.619\u20130.884), sensitivity 73.1%, specificity 64.9%, PPV 59.4%, NPV 77.4%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PAR could be a portable index to assess the activity and severity of CD. Several limitations of this study, such as the limited sample size and potential biases, should be overcome in the future via more extensive validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102524","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T13:46:12Z","timestamp":1762263972000},"page":"e102524","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Platelet-to-albumin ratio as an indicator for Crohn\u2019s disease activity and severity: a multicentre cross-sectional study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7333-3565","authenticated-orcid":false,"given":"Duo","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8171-0252","authenticated-orcid":false,"given":"Ziheng","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xiangya Hospital Central South University, Changsha, Hunan, China"},{"name":"National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, Hunan, China"},{"name":"Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer-Aided Diagnosis and Treatment for Digestive Disease, Changsha, Hunan, China"},{"name":"Gut-Liver Axis and Intestinal Barrier Research Center, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yani","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Xiangya Hospital Central South University, Changsha, Hunan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"2025120413253760000_15.11.e102524.1","doi-asserted-by":"crossref","unstructured":"Petagna L , Antonelli A , Ganini C , et al . Pathophysiology of Crohn\u2019s disease inflammation and recurrence. Biol Direct 2020;15. doi:10.1186\/s13062-020-00280-5","DOI":"10.1186\/s13062-020-00280-5"},{"key":"2025120413253760000_15.11.e102524.2","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.2147\/PPA.S118413","article-title":"Illness perceptions and stress: mediators between disease severity and psychological well-being and quality of life among patients with Crohn\u2019s disease","volume":"10","author":"Zhang","year":"2016","journal-title":"Patient Prefer Adherence"},{"key":"2025120413253760000_15.11.e102524.3","doi-asserted-by":"crossref","first-page":"662488","DOI":"10.3389\/fmed.2021.662488","article-title":"Body mass index and disease activity are associated with moderate to severe disability in Crohn\u2019s disease: a cross-sectional study in Shanghai","volume":"8","author":"Bian","year":"2021","journal-title":"Front Med"},{"key":"2025120413253760000_15.11.e102524.4","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2018.27"},{"key":"2025120413253760000_15.11.e102524.5","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2016.128"},{"key":"2025120413253760000_15.11.e102524.6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1046\/j.1365-2036.17.s2.17.x","article-title":"Review article: Crohn\u2019s disease: monitoring disease activity","volume":"17 Suppl 2","author":"Sostegni","year":"2003","journal-title":"Aliment Pharmacol Ther"},{"key":"2025120413253760000_15.11.e102524.7","doi-asserted-by":"crossref","unstructured":"Lin H , Bai Z , Wu Q , et al . Inflammatory indexes for assessing the severity and disease progression of ulcerative colitis: a single-center retrospective study. Front Public Health 2022;10. doi:10.3389\/fpubh.2022.851295","DOI":"10.3389\/fpubh.2022.851295"},{"key":"2025120413253760000_15.11.e102524.8","doi-asserted-by":"publisher","DOI":"10.1111\/ans.17852"},{"key":"2025120413253760000_15.11.e102524.9","doi-asserted-by":"crossref","first-page":"842362","DOI":"10.3389\/fimmu.2022.842362","article-title":"Platelet-to-albumin ratio: a novel iga nephropathy prognosis predictor","volume":"13","author":"Tan","year":"2022","journal-title":"Front Immunol"},{"key":"2025120413253760000_15.11.e102524.10","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s10067-022-06439-x","article-title":"Platelet to albumin ratio is an independent indicator for disease activity in ankylosing spondylitis","volume":"42","author":"Cui","year":"2023","journal-title":"Clin Rheumatol"},{"key":"2025120413253760000_15.11.e102524.11","doi-asserted-by":"crossref","unstructured":"Li A , Wang Z , Lv Q , et al . Prognostic utility of platelet-to-albumin ratio among critically ill patients with colorectal cancer: a propensity score matching study. J Oncol 2022;2022. doi:10.1155\/2022\/6107997","DOI":"10.1155\/2022\/6107997"},{"key":"2025120413253760000_15.11.e102524.12","doi-asserted-by":"crossref","unstructured":"Wei Y , Feng J , Ma J , et al . Characteristics of platelet-associated parameters and their predictive values in Chinese patients with affective disorders. BMC Psychiatry 2022;22. doi:10.1186\/s12888-022-03775-9","DOI":"10.1186\/s12888-022-03775-9"},{"key":"2025120413253760000_15.11.e102524.13","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjz187"},{"key":"2025120413253760000_15.11.e102524.14","doi-asserted-by":"crossref","first-page":"630","DOI":"10.14309\/ajg.0000000000000197","article-title":"Impact of obesity on disease activity and Patient-Reported Outcomes Measurement Information System (PROMIS) in inflammatory bowel diseases","volume":"114","author":"Jain","year":"2019","journal-title":"Am J Gastroenterol"},{"key":"2025120413253760000_15.11.e102524.15","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2007.146357"},{"key":"2025120413253760000_15.11.e102524.16","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.069476"},{"key":"2025120413253760000_15.11.e102524.17","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.7326\/0003-4819-68-5-1013","article-title":"Thrombocytosis in chronic inflammatory bowel disease","volume":"68","author":"Morowitz","year":"1968","journal-title":"Ann Intern Med"},{"key":"2025120413253760000_15.11.e102524.18","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-023-00834-4"},{"key":"2025120413253760000_15.11.e102524.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2004.04129.x"},{"key":"2025120413253760000_15.11.e102524.20","doi-asserted-by":"crossref","unstructured":"Chen R , Li L , Chao K , et al . Platelet-to-lymphocyte percentage ratio index: a simple non-invasive index to monitor the endoscopic activity in Crohn\u2019s disease. Therap Adv Gastroenterol 2020;13. doi:10.1177\/1756284820979442","DOI":"10.1177\/1756284820979442"},{"key":"2025120413253760000_15.11.e102524.21","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.cgh.2016.04.033","article-title":"Intestinal dilation and platelet:albumin ratio are predictors of surgery in stricturing small bowel Crohn\u2019s disease","volume":"14","author":"Stidham","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025120413253760000_15.11.e102524.22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2002697"},{"key":"2025120413253760000_15.11.e102524.23","doi-asserted-by":"publisher","DOI":"10.1097\/01.MIB.0000440614.83703.84"},{"key":"2025120413253760000_15.11.e102524.24","doi-asserted-by":"publisher","DOI":"10.12659\/msm.897460"},{"key":"2025120413253760000_15.11.e102524.25","doi-asserted-by":"crossref","unstructured":"Godala M , Gaszy\u0144ska E , Walczak K , et al . Evaluation of albumin, transferrin and transthyretin in inflammatory bowel disease patients as disease activity and nutritional status biomarkers. Nutrients 2023;15. doi:10.3390\/nu15153479","DOI":"10.3390\/nu15153479"},{"key":"2025120413253760000_15.11.e102524.26","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.2147\/JIR.S347161","article-title":"Serum albumin to globulin ratio is associated with the presence and severity of inflammatory bowel disease","volume":"Volume 15","author":"Wang","year":"2022","journal-title":"JIR"},{"key":"2025120413253760000_15.11.e102524.27","first-page":"195","article-title":"Nutritional status of patients with Crohn\u2019s disease","volume":"27","author":"Benjamin","year":"2008","journal-title":"Indian J Gastroenterol"},{"key":"2025120413253760000_15.11.e102524.28","doi-asserted-by":"publisher","DOI":"10.1002\/jpen.1451"},{"key":"2025120413253760000_15.11.e102524.29","doi-asserted-by":"publisher","DOI":"10.1007\/BF01692917"},{"key":"2025120413253760000_15.11.e102524.30","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1097\/MIB.0000000000000894","article-title":"High vitamin D-binding protein concentration, low albumin, and mode of remission predict relapse in Crohn\u2019s disease","volume":"22","author":"Ghaly","year":"2016","journal-title":"Inflamm Bowel Dis"},{"key":"2025120413253760000_15.11.e102524.31","doi-asserted-by":"crossref","unstructured":"Jab\u0142o\u0144ska B , Mrowiec S . Nutritional status and its detection in patients with inflammatory bowel diseases. Nutrients 2023;15. doi:10.3390\/nu15081991","DOI":"10.3390\/nu15081991"},{"key":"2025120413253760000_15.11.e102524.32","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.clnesp.2019.07.006","article-title":"Impaired nutritional status in outpatients in remission or with active Crohn\u2019s disease - classified by objective endoscopic and imaging assessments","volume":"33","author":"de Castro","year":"2019","journal-title":"Clin Nutr ESPEN"},{"key":"2025120413253760000_15.11.e102524.33","doi-asserted-by":"crossref","unstructured":"Huang J , Lu J , Jiang F , et al . Platelet\/Albumin ratio and plateletcrit levels are potential new biomarkers for assessing endoscopic inflammatory bowel disease severity. BMC Gastroenterol 2023;23. doi:10.1186\/s12876-023-03043-4","DOI":"10.1186\/s12876-023-03043-4"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-102524","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:26:13Z","timestamp":1764883573000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-102524"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":33,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,4]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-102524"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-102524","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}