Neutrophil count and platelet–lymphocyte ratio as simple predictors of ustekinumab response in patients with Crohn’s disease: a retrospective multicenter study

Introduction Although ustekinumab (UST) has been recommended by guidelines as a parallel first-line biologic agent for Crohn’s disease (CD), its efficacy varies among individuals. This study aimed to identify baseline clinical features and laboratory indicators that can predict clinical remission with UST to assist clinical decision-making. Methods This retrospective study collected data from patients with CD who received UST induction and maintenance therapy across multiple centers. The primary endpoint was the rate of clinical remission at week 48. Independent predictors of clinical remission were identified by multivariate logistic regression analysis. Receiver operating characteristic (ROC) curves and the Youden index were used to determine optimal cutoff values. Results Among the 157 included patients, clinical and endoscopic remission rates were 76.4% (120/157) and 51.6% (81/157), respectively. Multivariate analysis showed that baseline neutrophil count and baseline platelet–lymphocyte ratio (PLR) were independent predictors of clinical remission at week 48 with UST treatment. Area under the ROC curve values for baseline neutrophil count, baseline PLR, and their combination were 0.633, 0.709, and 0.769, respectively. Optimal cutoff values for baseline neutrophil count and baseline PLR were ≤4.135×10 9 /L and 237.912, respectively. Discussion Baseline neutrophil count and baseline PLR together constitute a simple and effective predictive model. This model may help identify patients who are more responsive to UST before treatment, offering a practical tool for individualized and precise treatment of CD.