Association of Inflammatory Biomarkers with Subclinical Cardiac Dysfunction in Inflammatory Bowel Disease: Roles of NLR, PLR, CRP/Alb, and MPV

Association of Inflammatory Biomarkers with Subclinical Cardiac Dysfunction in Inflammatory Bowel Disease: Roles of NLR, PLR, CRP/Alb, and MPV | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of Inflammatory Biomarkers with Subclinical Cardiac Dysfunction in Inflammatory Bowel Disease: Roles of NLR, PLR, CRP/Alb, and MPV Mehdi Pezeshgi-Modarres, Somayyeh Norouzi, Ehsan Vesali-Monfared, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8244067/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Inflammatory bowel disease (IBD) has an increased cardiovascular risk, but the relationship between systemic inflammation and subclinical cardiac dysfunction is poorly understood. The present research had the objective of investigating the relationships between inflammatory biomarkers and cardiac parameters in IBD patients. Methods: A cross-sectional study comprised 110 IBD patients who were evaluated for hematological indices (NLR, PLR, CRP/Albumin ratio, MPV) and echocardiographic indices. Disease severity was staged according to Truelove-Witts criteria. Statistical analysis included ANOVA and correlation tests. Results: The population studied was consisting of 47 females (42.7%) and 63 males (57.3%). The mean age was 42.15 ± 13.23 years. Findings showed a significantly increase in NLR and MPV in more severe disease (p<0.001). A significantly correlation was observed between CRP/albumin ratio and LVEDVI (r=0.21, p=0.044), and between NLR and QT interval (r=0.31, p=0.005), Also statistically significant correlation between QT Interval with NLR, PR Interval with PLR, and MPV with PR Interval. Left ventricular ejection fraction (LVEF) averaged 53.53±5.34%, within the normal range (≥50%), though some patients showed significant reduction (minimum 25%). Discussion: Inflammatory biomarkers exhibit distinct cardiac associations: NLR with repolarization, MPV/PLR with conduction, and CRP/Albumin with remodeling. The findings suggest the promise of biomarkers in the identification of IBD patients at risk of subclinical cardiac involvement and the requirement for longer-term validation. Inflammatory Bowel Diseases Heart Disease Risk Factors Biomarkers Cardiac 1 Introduction Inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, represents a chronic inflammatory condition with significant systemic manifestations. While the primary pathology affects the gastrointestinal tract, mounting evidence highlights the substantial cardiovascular burden in this population ( 1 , 2 ). Notably, IBD patients demonstrate a 10–30% increased risk of cardiovascular events compared to matched controls, independent of traditional risk factors ( 3 , 4 ). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein/albumin ratio (CAR), and mean platelet volume (MPV) have emerged as robust inflammatory biomarkers in IBD management ( 5 , 6 ). These indices correlate strongly with disease activity, with NLR and PLR demonstrating particular utility in monitoring intestinal inflammation ( 7 , 8 ). However, their potential role in predicting cardiovascular complications remains underexplored. Cardiac involvement in IBD presents a distinct pattern, with pericarditis accounting for approximately 70% of cardiovascular manifestations ( 9 ). Emerging data suggest subclinical myocardial dysfunction may occur even in asymptomatic patients ( 10 ). The inflammatory cascade in IBD, characterized by elevated cytokines and endothelial dysfunction, may directly contribute to cardiac pathology through myocardial fibrosis and microvascular dysfunction ( 11 , 12 ). Despite these observations, critical knowledge gaps persist. Current literature primarily focuses on overt cardiac events, while data on subclinical cardiac dysfunction are limited ( 13 ). Furthermore, the correlation between inflammatory biomarkers and echocardiographic parameters remains poorly characterized ( 14 ). This is particularly relevant given that conventional cardiac risk assessment tools often underestimate risk in IBD patients ( 15 ). This study aims to investigate the associations between inflammatory biomarkers (NLR, PLR, CAR, and MPV) and left cardiac parameters, evaluate their performance in predicting subclinical cardiac dysfunction, and establish potential clinical applications for cardiovascular risk stratification in IBD patients. Our findings may enable earlier detection of cardiac involvement and inform personalized monitoring strategies in this high-risk population, ultimately bridging the critical gap between gastroenterological and cardiovascular assessment to improve multidisciplinary care for IBD patients. By elucidating these relationships, this research could significantly enhance risk prediction models and guide more targeted surveillance approaches for cardiovascular complications in IBD. Inflammatory bowel disease (IBD) has an increased cardiovascular risk, but the relationship between systemic inflammation and subclinical cardiac dysfunction is poorly understood. The present research had the objective of investigating Association of Inflammatory Biomarkers with Subclinical Cardiac Dysfunction in Inflammatory Bowel Disease: Roles of NLR, PLR, CRP/Alb, and MPV 2. Methods 2.1 Study Design and Setting This cross-sectional study investigates the association of inflammatory biomarkers (NLR, PLR, CRP/Albumin ratio, MPV) with left cardiac findings and disease severity in patients with inflammatory bowel disease (IBD). The study was conducted at the Shahid Beheshti Hospital in Qom, Iran, from 2023 to 2024. Ethical approval was obtained from the Qom University of Medical Sciences Ethics Committee, and written informed consent was acquired from all participants. 2.2 Sample Size Calculation and Sampling Based on a reported correlation coefficient of 0.28 between neutrophil-to-lymphocyte ratio (NLR) and global longitudinal strain (GLS) in a prior study by Sari et al. [25], a sample size of 97 participants was calculated to achieve 80% power at a 5% significance level (α = 0.05) using G*Power software. Participants were recruited via convenience sampling from IBD patients (ulcerative colitis or Crohn’s disease) attending the gastroenterology clinic or admitted to Shahid Beheshti Hospital. 2.3 Inclusion and Exclusion Criteria Inclusion criteria: Age ≥18 years with confirmed IBD (ulcerative colitis or Crohn’s disease). Provision of written informed consent. Exclusion criteria: Severe heart failure or significant valvular dysfunction (>mild regurgitation/stenosis). Left ventricular hypertrophy (LVH), pathological Q wave, or ST-T changes on ECG. Ejection fraction (EF) 35 mmHg. History of ischemic heart disease or arrhythmias. 2.4 Data Collection Data were collected using a researcher-designed questionnaire capturing three domains (Supplementary File). Demographic and clinical characteristics included age, sex, body weight, and vital signs (blood pressure, heart rate, body temperature, and pulse oximetry). Laboratory and cardiac parameters encompassed: blood tests (CBC for calculating NLR, PLR, and MPV; CRP and albumin for CRP/Albumin ratio; ESR; ferritin; electrolytes); fecal calprotectin; ECG measurements (PR interval, QT interval, pathological Q waves, ST-T changes); and echocardiography parameters (LVEF, LVEDD, LVESD, LVEDVI, LVsd, PAP, left atrial volume index, E/e′ ratio), all interpreted by a cardiologist. Endoscopic findings and disease severity documented colonoscopy-based patterns of involvement (rectosigmoid, pancolitis, right-sided colitis, terminal ileum) with disease severity classified as mild, moderate, or severe using the Truelove and Witts criteria. 2.5. Statistical Analysis Data were analyzed using SPSS v.26. Continuous variables were expressed as mean ± SD or median (IQR), and categorical variables as frequencies (%). Correlations between biomarkers (NLR, PLR, CRP/Alb, MPV) and cardiac parameters were assessed using Pearson/Spearman tests. Regression models evaluated associations while adjusting for confounders. A p-value <0.05 was considered statistically significant. 3. Results 3.1. Demographic and Clinical Characteristics The study included 110 patients, consisting of 47 females (42.7%) and 63 males (57.3%). The mean age was 42.15 ± 13.23 years, mean weight 73.98 ± 10.83 kg, mean height 169.20 ± 9.36 cm, and mean disease duration 6.55 ± 3.14 years (Table 1 ). Table 1 Baseline Characteristics of IBD Patients Variable Mean/ Frequency SD/ Percentage p-value Age (years) 42.15 13.23 0.466 Gender Female Male 47 63 42.7% 57.3% 0.544 Height 169.20 9.36 0.259 Weight 73.98 10.83 0.892 Disease duration (years) 6.83 3.08 0.74 Table 2 presents descriptive statistics for various blood parameters. The wide ranges and significant standard deviations observed for most indicators suggest high dispersion and variability in the values of these parameters among the study participants Table 2 Hematological Parameters Variable N Mean ± SD Range p-value WBC 110 8.18 ± 3.20 3.19–17.30 0.039 Hb 110 12.07 ± 2.90 1.40–17.40 0.647 NLR 110 4.32 ± 3.75 0.49–18.04 0.459 PLR 110 2216 ± 25.94 2.82-220.08 0.525 CRP/Alb ratio 110 0.09 ± 0.15-6 0.00-.0.8 0.706 MPV (fL) 110 8.12 ± 2.82 1.98–11.87 0.109 3.2. Echocardiographic Findings The echocardiographic evaluation revealed generally preserved cardiac structure and function in most inflammatory bowel disease (IBD) patients. Left ventricular ejection fraction (LVEF) averaged 53.53 ± 5.34%, within the normal range (≥ 50%), though some patients showed significant reduction (minimum 25%). Ventricular dimensions, including end-diastolic diameter (LVEDD: 46.94 ± 3.46 mm) and end-systolic diameter (LVESD: 32.22 ± 7.42 mm), were largely within normal limits (35–56 mm and 20–40 mm, respectively). The left ventricular end-diastolic volume index (LVEDVI: 47.75 ± 11.57 ml/m²) fell slightly below the normal range (50–82 ml/m²), possibly indicating volume alterations. Posterior wall thickness (PWd: 8.29 ± 0.9 mm) remained normal (6–11 mm). These findings suggest maintained cardiac architecture in most IBD patients, though LVEDVI variations may reflect cardiovascular adaptations to chronic inflammation. The preserved systolic function (normal LVEF) contrasts with subtle diastolic changes, warranting further investigation into the long-term cardiac effects of IBD. The significant standard deviations (particularly for LVESD ± 7.42) highlight considerable interpatient variability in cardiac responses to systemic inflammation (Table 3 ). Table 3 Comprehensive Echocardiographic and ECG Parameters in IBD Patients Parameter Minimum Maximum Mean ± SD Normal Range LVEF (%) 25 60 53.53 ± 5.34 ≥ 50% LVEDD (mm) 37 57 46.94 ± 3.46 35–56 mm LVESD (mm) 8 69 32.22 ± 7.42 20–40 mm LVEDVI (ml/m²) 26 95.00 47.75 ± 11.57 50–82 ml/m² PAP (mmHg) - - 30.32 ± 7.56 - PR interval - - 0.17 ± 0.20 - QT interval - - 0.35 ± 0.37 - PWD 6 11 8.29 ± 0.9 - 3.3. Association of Biomarkers with Cardiac Findings Table 4 indicates that there is no significant correlation between most inflammatory markers (NLR and PLR) and cardiac functional and structural parameters (LVEF, LVEDD, LVESD). Only the CRP/Alb ratio shows a positive correlation (r = 0.21, p < 0.05) with the Left Ventricular End- Diastolic Volume Index (LVEDVI) (Table 4 ). Table 4 Association of Inflammatory Biomarkers with Cardiac Findings in IBD Patients Biomarker Cardiac Parameter Correlation (r) p-value NLR LVEF -0.088 0.377 LVEDD -0.020 0.843 LVESD -0.020 0.854 LVEDVI 0.159 0.126 PWD 0.054 0.596 PR Interval 0.139 0.198 QT Interval 0.239 0.031 PLR LVEF -0.098 0.348 LVEDD 0.020 0.846 LVESD -0.037 0.748 LVEDVI 0.084 0.446 PWD 0.020 0.854 PR Interval 0.313 0.005 QT Interval 0.164 0.160 CRP/Alb Ratio LVEF -0.119 0.229 LVEDD 0.144 0.146 LVESD 0.084 0.440 LVEDVI 0.208 0.044 PWD -0.018 0.864 PR Interval 0.125 0.246 QT Interval 0.044 0.696 MPV LVEF 0.046 0.701 LVEDD -0.110 0.359 LVESD -0.047 0.724 LVEDVI -0.073 0.572 PWD -0.004 0.975 PR Interval 0.284 0.035 QT Interval 0.180 0.216 3.4. Biomarkers and Disease Severity According to Table 5 , two inflammatory markers, NLR and MPV, are significantly associated with disease severity. NLR and MPV values progressively increase with rising disease severity, from mild to severe cases (p 0.05) (Table 5 ). Table 5 Inflammatory Markers by IBD Disease Severity Parameter Group Mean ± SD 95% CI F p-value (ANOVA) NLR Mild 3.94 ± 3.49 2.87–5.01 7.25 0.001 Moderate 3.63 ± 2.88 2.81–4.45 Severe 7.32 ± 5.21* 4.64–9.99 PLR Mild 19.37 ± 16.36 14.13–24.60 050 0.611 Moderate 23.07 ± 32.78 13.11–33.04 Severe 26.66 ± 24.88 13.40-39.92 MPV Mild 5.18 ± 2.74† 4.02–6.34 52.23 0.001 Moderate 9.08 ± 1.14 8.67–9.49 Severe 10.71 ± 0.79* 10.28–11.15 CRP/Alb Mild 0.07 ± 0.16 0.02–0.12 025 0.780 Moderate 0.10 ± 0.17 0.05–0.14 Severe 0.10 ± 0.15 0.02–0.17 4. Discussion This study provides novel insights into the association between inflammatory biomarkers and cardiac parameters in patients with IBD. Our findings demonstrate significant relationships between specific biomarkers and cardiac function, highlighting the potential cardiovascular implications of chronic inflammation in IBD. Our results showed a significant correlation between the NLR and prolonged QT interval in patients with IBD. This finding suggests that systemic inflammation reflected in elevated NLR levels may affect cardiac repolarization. In one study, this correlation was reported as r = 0.239 and p = 0.031, indicating that higher levels of inflammation may be associated with changes in cardiac electrical activity and increased risk of arrhythmia ( 16 ). Chronic inflammation, which is common in IBD patients, can lead to electrolyte imbalances and other factors that contribute to QT interval prolongation. This is significant because prolonged QT interval is associated with serious cardiac events, including dangerous arrhythmias ( 17 ). These findings align with prior research indicating that inflammatory mediators can disrupt cardiac ion channels, potentially increasing the risk of subclinical cardiotoxicity in IBD patients ( 18 ). A strong correlation was also observed between the PLR and PR interval (r = 0.313, p = 0.005), suggesting that platelet-lymphocyte interactions may affect atrioventricular conduction. This finding supports emerging evidence about inflammation-induced conduction system abnormalities in chronic inflammatory conditions ( 18 ). The association of PLR with conduction parameters rather than structural metrics indicates that this marker may be particularly valuable for detecting electrophysiological changes in IBD patients ( 19 ). These results contribute to a better understanding of inflammation's effects on the cardiac conduction system and highlight the importance of monitoring these parameters in patients with IBD ( 20 ). The correlation between CRP/Alb and LVEDVI (r = 0.208, p = 0.044) indicates that the combination of inflammation (CRP) and nutritional status (albumin) may play a role in ventricular remodeling. This finding aligns with studies demonstrating inflammation-driven myocardial alterations in chronic diseases ( 21 ). The CRP/Alb ratio may serve as a composite marker reflecting inflammatory burden and its cardiac consequences. This marker could help identify patients at high risk of cardiac complications, highlighting the importance of monitoring both inflammatory and nutritional status in chronic disease patients ( 22 ). Collectively, these results suggest CRP/Alb ratio could be a clinically useful tool for cardiovascular assessment in chronic inflammatory conditions. Our results also revealed a significant correlation between MPV and PR interval, suggesting that platelet activation reflected by increased MPV, may contribute to cardiac conduction system alterations. This observation supports the growing recognition of inflammation's role in platelet activation within cardiovascular pathology ( 23 ). Elevated MPV is associated with various cardiovascular conditions and may be considered a valuable biomarker for cardiovascular risk assessment ( 24 ). The link between inflammation and thrombosis, particularly through mechanisms like immunothrombosis, further underscores the significance of platelet activation in cardiovascular diseases ( 23 ). Our results indicate that routine monitoring of inflammatory markers in IBD patients may help identify individuals at risk of cardiac complications. The distinct associations observed (NLR with repolarization, PLR/MPV with conduction, CRP/Alb with remodeling) suggest these biomarkers may provide complementary information about different aspects of cardiac involvement. Preserved systolic function (normal LVEF) despite subtle diastolic changes (altered LVEDVI) underscores the importance of comprehensive cardiac assessment in IBD patients, as conventional metrics may miss early cardiac dysfunction ( 23 ). This study had several limitations, including: a cross-sectional design that restricted causal inference; a single-center setting that may affect the generalizability of findings; and a relatively small sample size that reduced statistical power for some subgroup analyses. 5. Conclusion Our study demonstrated significant associations between inflammatory markers (NLR, PLR, CRP/Alb ratio, MPV) and specific cardiac parameters in IBD patients. Furthermore, our findings indicate that chronic inflammation in IBD may contribute to various cardiac abnormalities, including conduction disorders, repolarization abnormalities, and ventricular remodeling. Incorporating these markers into routine cardiovascular risk assessment could improve early detection of cardiac involvement in IBD patients, enabling timely intervention and improved outcomes Declarations Ethical Considerations Compliance with ethical guidelines This study complied with all ethical principles of research. This study was approved by the Research Ethics Committee of Qom University of Medical Sciences, Qom, Iran (Code: IR.MUQ.REC.1403.232). Funding This study did not receive any financial support from funding organizations in the private or public sector. Authors' contributions All authors equally contributed to this study. Conflict of interest The authors declared no conflict of interest. Acknowledgments The authors are grateful to the Vice-Chancellor for Research and Technology of Qom University of Medical Sciences and the Vice-Chancellor for Research at the School of Medicine, Qom University of Medical Sciences, Qom, Iran Data Availability The data that support the findings of this study are available from [third party name] but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of [third party name]. References Fiocchi C. IBD: advances in pathogenesis, complications, diagnosis, and therapy. Curr Opin Gastroenterol. 2012;28(4):297–300. Nowotarska A, Błaszczyński G, Nojek P, Pawlik W, Zimonczyk M, Zawół M, et al. The impact of diet on the inflammatory bowel disease course–a literature review. J Educ Health Sport. 2024;71:56049. Larsen S, Bendtzen K, Nielsen OH. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management. Ann Med. 2010;42(2):97–114. Massart A, Hunt DP. Pulmonary manifestations of inflammatory bowel disease. Am J Med. 2020;133(1):39–43. Olpin JD, Sjoberg BP, Stilwill SE, Jensen LE, Rezvani M, Shaaban AM. Beyond the bowel: extraintestinal manifestations of inflammatory bowel disease. Radiographics. 2017;37(4):1135–60. Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. Extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(8):1982–92. Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36(5):491–7. Öztürk Z, Dag M, Kuyumcu M, Cam H, Yesil Y, Yilmaz N et al. Could platelet indices be new biomarkers for inflammatory bowel diseases? Eur Rev Med Pharmacol Sci. 2013;17(3). Yarur AJ, Deshpande AR, Pechman DM, Tamariz L, Abreu MT, Sussman DA. Inflammatory bowel disease is associated with an increased incidence of cardiovascular events. Official J Am Coll Gastroenterology| ACG. 2011;106(4):741–7. Zanoli L, Cannavo M, Rastelli S, Di Pino L, Monte I, Di Gangi M, et al. Arterial stiffness is increased in patients with inflammatory bowel disease. J Hypertens. 2012;30(9):1775–81. Papa A, Santoliquido A, Danese S, Covino M, Campli CD, Urgesi R, et al. Increased carotid intima–media thickness in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2005;22(9):839–46. Wu H, Xu M, Hao H, Hill MA, Xu C, Liu Z. Endothelial dysfunction and arterial stiffness in patients with inflammatory bowel disease: a systematic review and meta-analysis. J Clin Med. 2022;11(11):3179. Bernstein CN, Wajda A, Blanchard JF. The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study. Clin Gastroenterol Hepatol. 2008;6(1):41–5. Dewey M, Schnapauff D, Teige F, Hamm B. Non-cardiac findings on coronary computed tomography and magnetic resonance imaging. Eur Radiol. 2007;17(8):2038–43. Fumery M, Xiaocang C, Dauchet L, Gower-Rousseau C, Peyrin-Biroulet L, Colombel J-F. Thromboembolic events and cardiovascular mortality in inflammatory bowel diseases: a meta-analysis of observational studies. J Crohn's Colitis. 2014;8(6):469–79. Langley BO, Guedry SE, Goldenberg JZ, Hanes DA, Beardsley JA, Ryan JJ. Inflammatory bowel disease and neutrophil–lymphocyte ratio: a systematic scoping review. J Clin Med. 2021;10(18):4219. Acarturk G, Acay A, Demir K, Ulu M, Ahsen A, Yuksel S. Neutrophil-to-lymphocyte ratio in inflammatory bowel disease-as a new predictor of disease severity. Bratisl Lek Listy. 2015;116(4):213–7. Li P, Wu Y, Xiong W, Cao J, Chen M, Yuan Z, et al. Association between the immune-inflammation index and the severity and clinical outcomes of patients with inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol. 2025;25(1):1–15. Patel DM, Patel DK, Patel MM, Patel LB, Shaikh RT, Shaikh NT, et al. Neutrophil-lymphocyte, Lymphocyte-monocyte, and Platelet-lymphocyte Ratios: Non-invasive Biomarkers for Assessing Inflammatory Bowel Disease Activity. Recent Advances in Inflammation & Allergy Drug Discovery; 2024. Carrillo-Palau M, Vera-Santana B, Morant-Domínguez A, Hernández-Camba A, Ramos L, Alonso-Abreu I, et al. Hematological composite scores in patients with inflammatory bowel disease. J Clin Med. 2023;12(23):7248. Chen Y-H, Wang L, Feng S-Y, Cai W-M, Chen X-F, Huang Z-M. The relationship between C-reactive protein/albumin ratio and disease activity in patients with inflammatory bowel disease. Gastroenterol Res Pract. 2020;2020(1):3467419. Qin G, Tu J, Liu L, Luo L, Wu J, Tao L, et al. Serum albumin and C-reactive protein/albumin ratio are useful biomarkers of Crohn’s disease activity. Med Sci Monit. 2016;22:4393–400. Stark K, Massberg S. Interplay between inflammation and thrombosis in cardiovascular pathology. Nat Reviews Cardiol. 2021;18(9):666–82. Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas KM, Kitas GD. Association of mean platelet volume with hypertension in rheumatoid arthritis. Inflammation & Allergy-Drug Targets (Formerly Current Drug Targets-Inflammation & Allergy)(Discontinued). 2010;9(1):45–50. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8244067","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588832289,"identity":"b499e0be-7659-4888-aa70-c066506aa7bd","order_by":0,"name":"Mehdi Pezeshgi-Modarres","email":"","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mehdi","middleName":"","lastName":"Pezeshgi-Modarres","suffix":""},{"id":588832290,"identity":"5c4da192-45c1-4779-b71e-470bc6186c03","order_by":1,"name":"Somayyeh Norouzi","email":"","orcid":"","institution":"Qom University of Medical Science and Health Services","correspondingAuthor":false,"prefix":"","firstName":"Somayyeh","middleName":"","lastName":"Norouzi","suffix":""},{"id":588832291,"identity":"80a14b50-f886-4d86-8cb9-904b316ecbed","order_by":2,"name":"Ehsan Vesali-Monfared","email":"","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ehsan","middleName":"","lastName":"Vesali-Monfared","suffix":""},{"id":588832292,"identity":"291bfffd-0b6b-41ba-a67f-4ca83d89c4c8","order_by":3,"name":"Zeinab sadat asimeh","email":"","orcid":"","institution":"Islamic Azad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zeinab","middleName":"sadat","lastName":"asimeh","suffix":""},{"id":588832293,"identity":"df29695d-83f3-46ae-92ba-bd99efc7181e","order_by":4,"name":"Alireza Kalhor","email":"","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Alireza","middleName":"","lastName":"Kalhor","suffix":""},{"id":588832294,"identity":"2123bca4-e267-4a67-940b-a5fb08922fa6","order_by":5,"name":"Mohammad Reza Ahmadi","email":"","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Reza","lastName":"Ahmadi","suffix":""},{"id":588832295,"identity":"a2cdf4de-e6ed-4c07-aa3b-a90dba447bf1","order_by":6,"name":"Vida Bozorgi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYDACCQjFww8TYCNai2QDqVoYDA4Q6y6D282HP3zcUytjfO2M4Q2GGjsGPmkCmg3uHEswnPHsOI/Z7RxjC4ZjyQxsfAn4tUjOyDFI5jlwDKTFTIKB7QADGw8Bh4G0HAZpMZ4N0vKPCC38EjmGzTwHangMpIFaGNuI0SJzLJlxxoEDPBK304otEvuSeQhqYZMGhtiHA3X2/LOTN9748M1OTr6HgBYoOAwmJRKAcUqcBgaGOogWYpWPglEwCkbByAIARIU5RwtsO14AAAAASUVORK5CYII=","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Vida","middleName":"","lastName":"Bozorgi","suffix":""}],"badges":[],"createdAt":"2025-11-30 19:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8244067/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8244067/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102447513,"identity":"622977c0-811b-490c-a36e-1fda72155978","added_by":"auto","created_at":"2026-02-11 17:55:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":775008,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8244067/v1/aaa00048-0e19-4166-9fad-96d3ebf9a36b.pdf"},{"id":102447371,"identity":"00d7667d-91ae-4a4e-9c68-cf4544f6a6f4","added_by":"auto","created_at":"2026-02-11 17:55:02","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14728,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-8244067/v1/bb403ef1069740c97fcf454a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of Inflammatory Biomarkers with Subclinical Cardiac Dysfunction in Inflammatory Bowel Disease: Roles of NLR, PLR, CRP/Alb, and MPV","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eInflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, represents a chronic inflammatory condition with significant systemic manifestations. While the primary pathology affects the gastrointestinal tract, mounting evidence highlights the substantial cardiovascular burden in this population (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Notably, IBD patients demonstrate a 10\u0026ndash;30% increased risk of cardiovascular events compared to matched controls, independent of traditional risk factors (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein/albumin ratio (CAR), and mean platelet volume (MPV) have emerged as robust inflammatory biomarkers in IBD management (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These indices correlate strongly with disease activity, with NLR and PLR demonstrating particular utility in monitoring intestinal inflammation (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, their potential role in predicting cardiovascular complications remains underexplored. Cardiac involvement in IBD presents a distinct pattern, with pericarditis accounting for approximately 70% of cardiovascular manifestations (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Emerging data suggest subclinical myocardial dysfunction may occur even in asymptomatic patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The inflammatory cascade in IBD, characterized by elevated cytokines and endothelial dysfunction, may directly contribute to cardiac pathology through myocardial fibrosis and microvascular dysfunction (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Despite these observations, critical knowledge gaps persist. Current literature primarily focuses on overt cardiac events, while data on subclinical cardiac dysfunction are limited (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Furthermore, the correlation between inflammatory biomarkers and echocardiographic parameters remains poorly characterized (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This is particularly relevant given that conventional cardiac risk assessment tools often underestimate risk in IBD patients (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This study aims to investigate the associations between inflammatory biomarkers (NLR, PLR, CAR, and MPV) and left cardiac parameters, evaluate their performance in predicting subclinical cardiac dysfunction, and establish potential clinical applications for cardiovascular risk stratification in IBD patients. Our findings may enable earlier detection of cardiac involvement and inform personalized monitoring strategies in this high-risk population, ultimately bridging the critical gap between gastroenterological and cardiovascular assessment to improve multidisciplinary care for IBD patients. By elucidating these relationships, this research could significantly enhance risk prediction models and guide more targeted surveillance approaches for cardiovascular complications in IBD. Inflammatory bowel disease (IBD) has an increased cardiovascular risk, but the relationship between systemic inflammation and subclinical cardiac dysfunction is poorly understood. The present research had the objective of investigating Association of Inflammatory Biomarkers with Subclinical Cardiac Dysfunction in Inflammatory Bowel Disease: Roles of NLR, PLR, CRP/Alb, and MPV\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cem\u003e2.1 Study Design and Setting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study investigates the association of inflammatory biomarkers (NLR, PLR, CRP/Albumin ratio, MPV) with left cardiac findings and disease severity in patients with inflammatory bowel disease (IBD). The study was conducted at the Shahid Beheshti Hospital in Qom, Iran, from 2023 to 2024. Ethical approval was obtained from the Qom University of Medical Sciences Ethics Committee, and written informed consent was acquired from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.2 Sample Size Calculation and Sampling\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBased on a reported correlation coefficient of 0.28 between neutrophil-to-lymphocyte ratio (NLR) and global longitudinal strain (GLS) in a prior study by Sari et al. [25], a sample size of \u003cstrong\u003e97\u0026nbsp;\u003c/strong\u003eparticipants was calculated to achieve 80% power at a 5% significance level (α = 0.05) using G*Power software. Participants were recruited via convenience sampling from IBD patients (ulcerative colitis or Crohn’s disease) attending the gastroenterology clinic or admitted to Shahid Beheshti Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3 Inclusion and Exclusion Criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion criteria:\u003c/em\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAge ≥18 years with confirmed IBD (ulcerative colitis or Crohn’s disease).\u003c/li\u003e\n \u003cli\u003eProvision of written informed consent.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003eExclusion criteria:\u003c/em\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eSevere heart failure or significant valvular dysfunction (\u0026gt;mild regurgitation/stenosis).\u003c/li\u003e\n \u003cli\u003eLeft ventricular hypertrophy (LVH), pathological Q wave, or ST-T changes on ECG.\u003c/li\u003e\n \u003cli\u003eEjection fraction (EF) \u0026lt;50%.\u003c/li\u003e\n \u003cli\u003ePulmonary arterial pressure (PAP) \u0026gt;35 mmHg.\u003c/li\u003e\n \u003cli\u003eHistory of ischemic heart disease or arrhythmias.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003e2.4 Data Collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a researcher-designed questionnaire capturing three domains\u0026nbsp;(Supplementary File).\u0026nbsp;Demographic and clinical characteristics included age, sex, body weight, and vital signs (blood pressure, heart rate, body temperature, and pulse oximetry). Laboratory and cardiac parameters encompassed: blood tests (CBC for calculating NLR, PLR, and MPV; CRP and albumin for CRP/Albumin ratio; ESR; ferritin; electrolytes); fecal calprotectin; ECG measurements (PR interval, QT interval, pathological Q waves, ST-T changes); and echocardiography parameters (LVEF, LVEDD, LVESD, LVEDVI, LVsd, PAP, left atrial volume index, E/e′ ratio), all interpreted by a cardiologist. Endoscopic findings and disease severity documented colonoscopy-based patterns of involvement (rectosigmoid, pancolitis, right-sided colitis, terminal ileum) with disease severity classified as mild, moderate, or severe using the Truelove and Witts criteria.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.5. Statistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS v.26. Continuous variables were expressed as mean ± SD or median (IQR), and categorical variables as frequencies (%). Correlations between biomarkers (NLR, PLR, CRP/Alb, MPV) and cardiac parameters were assessed using Pearson/Spearman tests. Regression models evaluated associations while adjusting for confounders. A p-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographic and Clinical Characteristics\u003c/h2\u003e \u003cp\u003eThe study included 110 patients, consisting of 47 females (42.7%) and 63 males (57.3%). The mean age was 42.15\u0026thinsp;\u0026plusmn;\u0026thinsp;13.23 years, mean weight 73.98\u0026thinsp;\u0026plusmn;\u0026thinsp;10.83 kg, mean height 169.20\u0026thinsp;\u0026plusmn;\u0026thinsp;9.36 cm, and mean disease duration 6.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.14 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of IBD Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean/ Frequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD/ Percentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender Female\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.7%\u003c/p\u003e \u003cp\u003e57.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease duration (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents descriptive statistics for various blood parameters. The wide ranges and significant standard deviations observed for most indicators suggest high dispersion and variability in the values of these parameters among the study participants\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHematological Parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.19\u0026ndash;17.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.40\u0026ndash;17.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.49\u0026ndash;18.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2216\u0026thinsp;\u0026plusmn;\u0026thinsp;25.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.82-220.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP/Alb ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15-6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00-.0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMPV (fL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.98\u0026ndash;11.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Echocardiographic Findings\u003c/h2\u003e \u003cp\u003eThe echocardiographic evaluation revealed generally preserved cardiac structure and function in most inflammatory bowel disease (IBD) patients. Left ventricular ejection fraction (LVEF) averaged 53.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34%, within the normal range (\u0026ge;\u0026thinsp;50%), though some patients showed significant reduction (minimum 25%). Ventricular dimensions, including end-diastolic diameter (LVEDD: 46.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46 mm) and end-systolic diameter (LVESD: 32.22\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42 mm), were largely within normal limits (35\u0026ndash;56 mm and 20\u0026ndash;40 mm, respectively). The left ventricular end-diastolic volume index (LVEDVI: 47.75\u0026thinsp;\u0026plusmn;\u0026thinsp;11.57 ml/m\u0026sup2;) fell slightly below the normal range (50\u0026ndash;82 ml/m\u0026sup2;), possibly indicating volume alterations. Posterior wall thickness (PWd: 8.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 mm) remained normal (6\u0026ndash;11 mm). These findings suggest maintained cardiac architecture in most IBD patients, though LVEDVI variations may reflect cardiovascular adaptations to chronic inflammation. The preserved systolic function (normal LVEF) contrasts with subtle diastolic changes, warranting further investigation into the long-term cardiac effects of IBD. The significant standard deviations (particularly for LVESD\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42) highlight considerable interpatient variability in cardiac responses to systemic inflammation (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComprehensive Echocardiographic and ECG Parameters in IBD Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNormal Range\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e53.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEDD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e46.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u0026ndash;56 mm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVESD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e32.22\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u0026ndash;40 mm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEDVI (ml/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e47.75\u0026thinsp;\u0026plusmn;\u0026thinsp;11.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50\u0026ndash;82 ml/m\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e30.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQT interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePWD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e8.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Association of Biomarkers with Cardiac Findings\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicates that there is no significant correlation between most inflammatory markers (NLR and PLR) and cardiac functional and structural parameters (LVEF, LVEDD, LVESD). Only the CRP/Alb ratio shows a positive correlation (r\u0026thinsp;=\u0026thinsp;0.21, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) with the Left Ventricular End- Diastolic Volume Index (LVEDVI) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of Inflammatory Biomarkers with Cardiac Findings in IBD Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiomarker\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac Parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrelation (r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEDVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePWD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.596\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePR Interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQT Interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.846\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEDVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePWD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePR Interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQT Interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eCRP/Alb Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.440\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEDVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePWD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePR Interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQT Interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.696\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eMPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.359\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVESD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLVEDVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePWD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePR Interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQT Interval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Biomarkers and Disease Severity\u003c/h2\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, two inflammatory markers, NLR and MPV, are significantly associated with disease severity. NLR and MPV values progressively increase with rising disease severity, from mild to severe cases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, PLR and the CRP/Alb ratio show no statistically significant association with disease severity (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInflammatory Markers by IBD Disease Severity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value (ANOVA)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.87\u0026ndash;5.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.81\u0026ndash;4.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.64\u0026ndash;9.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.37\u0026thinsp;\u0026plusmn;\u0026thinsp;16.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.13\u0026ndash;24.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.07\u0026thinsp;\u0026plusmn;\u0026thinsp;32.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.11\u0026ndash;33.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26.66\u0026thinsp;\u0026plusmn;\u0026thinsp;24.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.40-39.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.02\u0026ndash;6.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e52.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.67\u0026ndash;9.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.28\u0026ndash;11.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCRP/Alb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u0026ndash;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.05\u0026ndash;0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u0026ndash;0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study provides novel insights into the association between inflammatory biomarkers and cardiac parameters in patients with IBD. Our findings demonstrate significant relationships between specific biomarkers and cardiac function, highlighting the potential cardiovascular implications of chronic inflammation in IBD. Our results showed a significant correlation between the NLR and prolonged QT interval in patients with IBD. This finding suggests that systemic inflammation reflected in elevated NLR levels may affect cardiac repolarization. In one study, this correlation was reported as r\u0026thinsp;=\u0026thinsp;0.239 and p\u0026thinsp;=\u0026thinsp;0.031, indicating that higher levels of inflammation may be associated with changes in cardiac electrical activity and increased risk of arrhythmia (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Chronic inflammation, which is common in IBD patients, can lead to electrolyte imbalances and other factors that contribute to QT interval prolongation. This is significant because prolonged QT interval is associated with serious cardiac events, including dangerous arrhythmias (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These findings align with prior research indicating that inflammatory mediators can disrupt cardiac ion channels, potentially increasing the risk of subclinical cardiotoxicity in IBD patients (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A strong correlation was also observed between the PLR and PR interval (r\u0026thinsp;=\u0026thinsp;0.313, p\u0026thinsp;=\u0026thinsp;0.005), suggesting that platelet-lymphocyte interactions may affect atrioventricular conduction. This finding supports emerging evidence about inflammation-induced conduction system abnormalities in chronic inflammatory conditions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The association of PLR with conduction parameters rather than structural metrics indicates that this marker may be particularly valuable for detecting electrophysiological changes in IBD patients (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). These results contribute to a better understanding of inflammation's effects on the cardiac conduction system and highlight the importance of monitoring these parameters in patients with IBD (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The correlation between CRP/Alb and LVEDVI (r\u0026thinsp;=\u0026thinsp;0.208, p\u0026thinsp;=\u0026thinsp;0.044) indicates that the combination of inflammation (CRP) and nutritional status (albumin) may play a role in ventricular remodeling. This finding aligns with studies demonstrating inflammation-driven myocardial alterations in chronic diseases (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The CRP/Alb ratio may serve as a composite marker reflecting inflammatory burden and its cardiac consequences. This marker could help identify patients at high risk of cardiac complications, highlighting the importance of monitoring both inflammatory and nutritional status in chronic disease patients (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Collectively, these results suggest CRP/Alb ratio could be a clinically useful tool for cardiovascular assessment in chronic inflammatory conditions. Our results also revealed a significant correlation between MPV and PR interval, suggesting that platelet activation reflected by increased MPV, may contribute to cardiac conduction system alterations. This observation supports the growing recognition of inflammation's role in platelet activation within cardiovascular pathology (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Elevated MPV is associated with various cardiovascular conditions and may be considered a valuable biomarker for cardiovascular risk assessment (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The link between inflammation and thrombosis, particularly through mechanisms like immunothrombosis, further underscores the significance of platelet activation in cardiovascular diseases (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Our results indicate that routine monitoring of inflammatory markers in IBD patients may help identify individuals at risk of cardiac complications. The distinct associations observed (NLR with repolarization, PLR/MPV with conduction, CRP/Alb with remodeling) suggest these biomarkers may provide complementary information about different aspects of cardiac involvement. Preserved systolic function (normal LVEF) despite subtle diastolic changes (altered LVEDVI) underscores the importance of comprehensive cardiac assessment in IBD patients, as conventional metrics may miss early cardiac dysfunction (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This study had several limitations, including: a cross-sectional design that restricted causal inference; a single-center setting that may affect the generalizability of findings; and a relatively small sample size that reduced statistical power for some subgroup analyses.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur study demonstrated significant associations between inflammatory markers (NLR, PLR, CRP/Alb ratio, MPV) and specific cardiac parameters in IBD patients. Furthermore, our findings indicate that chronic inflammation in IBD may contribute to various cardiac abnormalities, including conduction disorders, repolarization abnormalities, and ventricular remodeling. Incorporating these markers into routine cardiovascular risk assessment could improve early detection of cardiac involvement in IBD patients, enabling timely intervention and improved outcomes\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with ethical guidelines\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study complied with all ethical principles of research. This study was approved by the\u003c/p\u003e\n\u003cp\u003eResearch Ethics Committee of Qom University of Medical Sciences, Qom, Iran (Code:\u003c/p\u003e\n\u003cp\u003eIR.MUQ.REC.1403.232).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any financial support from funding organizations in the private or public sector.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors equally contributed to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the Vice-Chancellor for Research and Technology of Qom University of Medical Sciences and the Vice-Chancellor for Research at the School of Medicine, Qom University of Medical Sciences, Qom, Iran\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from [third party name] but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of [third party name].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFiocchi C. IBD: advances in pathogenesis, complications, diagnosis, and therapy. Curr Opin Gastroenterol. 2012;28(4):297\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNowotarska A, Błaszczyński G, Nojek P, Pawlik W, Zimonczyk M, Zaw\u0026oacute;ł M, et al. The impact of diet on the inflammatory bowel disease course\u0026ndash;a literature review. J Educ Health Sport. 2024;71:56049.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLarsen S, Bendtzen K, Nielsen OH. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management. Ann Med. 2010;42(2):97\u0026ndash;114.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMassart A, Hunt DP. Pulmonary manifestations of inflammatory bowel disease. Am J Med. 2020;133(1):39\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlpin JD, Sjoberg BP, Stilwill SE, Jensen LE, Rezvani M, Shaaban AM. Beyond the bowel: extraintestinal manifestations of inflammatory bowel disease. Radiographics. 2017;37(4):1135\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. Extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(8):1982\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36(5):491\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ouml;zt\u0026uuml;rk Z, Dag M, Kuyumcu M, Cam H, Yesil Y, Yilmaz N et al. Could platelet indices be new biomarkers for inflammatory bowel diseases? Eur Rev Med Pharmacol Sci. 2013;17(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYarur AJ, Deshpande AR, Pechman DM, Tamariz L, Abreu MT, Sussman DA. Inflammatory bowel disease is associated with an increased incidence of cardiovascular events. Official J Am Coll Gastroenterology| ACG. 2011;106(4):741\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZanoli L, Cannavo M, Rastelli S, Di Pino L, Monte I, Di Gangi M, et al. Arterial stiffness is increased in patients with inflammatory bowel disease. J Hypertens. 2012;30(9):1775\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapa A, Santoliquido A, Danese S, Covino M, Campli CD, Urgesi R, et al. Increased carotid intima\u0026ndash;media thickness in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2005;22(9):839\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu H, Xu M, Hao H, Hill MA, Xu C, Liu Z. Endothelial dysfunction and arterial stiffness in patients with inflammatory bowel disease: a systematic review and meta-analysis. J Clin Med. 2022;11(11):3179.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernstein CN, Wajda A, Blanchard JF. The incidence of arterial thromboembolic diseases in inflammatory bowel disease: a population-based study. Clin Gastroenterol Hepatol. 2008;6(1):41\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDewey M, Schnapauff D, Teige F, Hamm B. Non-cardiac findings on coronary computed tomography and magnetic resonance imaging. Eur Radiol. 2007;17(8):2038\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFumery M, Xiaocang C, Dauchet L, Gower-Rousseau C, Peyrin-Biroulet L, Colombel J-F. Thromboembolic events and cardiovascular mortality in inflammatory bowel diseases: a meta-analysis of observational studies. J Crohn's Colitis. 2014;8(6):469\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLangley BO, Guedry SE, Goldenberg JZ, Hanes DA, Beardsley JA, Ryan JJ. Inflammatory bowel disease and neutrophil\u0026ndash;lymphocyte ratio: a systematic scoping review. J Clin Med. 2021;10(18):4219.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAcarturk G, Acay A, Demir K, Ulu M, Ahsen A, Yuksel S. Neutrophil-to-lymphocyte ratio in inflammatory bowel disease-as a new predictor of disease severity. Bratisl Lek Listy. 2015;116(4):213\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi P, Wu Y, Xiong W, Cao J, Chen M, Yuan Z, et al. Association between the immune-inflammation index and the severity and clinical outcomes of patients with inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol. 2025;25(1):1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel DM, Patel DK, Patel MM, Patel LB, Shaikh RT, Shaikh NT, et al. Neutrophil-lymphocyte, Lymphocyte-monocyte, and Platelet-lymphocyte Ratios: Non-invasive Biomarkers for Assessing Inflammatory Bowel Disease Activity. Recent Advances in Inflammation \u0026amp; Allergy Drug Discovery; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarrillo-Palau M, Vera-Santana B, Morant-Dom\u0026iacute;nguez A, Hern\u0026aacute;ndez-Camba A, Ramos L, Alonso-Abreu I, et al. Hematological composite scores in patients with inflammatory bowel disease. J Clin Med. 2023;12(23):7248.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Y-H, Wang L, Feng S-Y, Cai W-M, Chen X-F, Huang Z-M. The relationship between C-reactive protein/albumin ratio and disease activity in patients with inflammatory bowel disease. Gastroenterol Res Pract. 2020;2020(1):3467419.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin G, Tu J, Liu L, Luo L, Wu J, Tao L, et al. Serum albumin and C-reactive protein/albumin ratio are useful biomarkers of Crohn\u0026rsquo;s disease activity. Med Sci Monit. 2016;22:4393\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStark K, Massberg S. Interplay between inflammation and thrombosis in cardiovascular pathology. Nat Reviews Cardiol. 2021;18(9):666\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas KM, Kitas GD. Association of mean platelet volume with hypertension in rheumatoid arthritis. Inflammation \u0026amp; Allergy-Drug Targets (Formerly Current Drug Targets-Inflammation \u0026amp; Allergy)(Discontinued). 2010;9(1):45\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Inflammatory Bowel Diseases, Heart Disease, Risk Factors, Biomarkers, Cardiac ","lastPublishedDoi":"10.21203/rs.3.rs-8244067/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8244067/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eInflammatory bowel disease (IBD) has an increased cardiovascular risk, but the relationship between systemic inflammation and subclinical cardiac dysfunction is poorly understood. The present research had the objective of investigating the relationships between inflammatory biomarkers and cardiac parameters in IBD patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cross-sectional study comprised 110 IBD patients who were evaluated for hematological indices (NLR, PLR, CRP/Albumin ratio, MPV) and echocardiographic indices. Disease severity was staged according to Truelove-Witts criteria. Statistical analysis included ANOVA and correlation tests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The population studied was consisting of 47 females (42.7%) and 63 males (57.3%). The mean age was 42.15 ± 13.23 years. Findings showed a significantly increase in NLR and MPV in more severe disease (p\u0026lt;0.001). A significantly correlation was observed between CRP/albumin ratio and LVEDVI (r=0.21, p=0.044), and between NLR and QT interval (r=0.31, p=0.005), Also statistically significant correlation between QT Interval with NLR, PR Interval with PLR, and MPV with PR Interval. Left ventricular ejection fraction (LVEF) averaged 53.53±5.34%, within the normal range (≥50%), though some patients showed significant reduction (minimum 25%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e Inflammatory biomarkers exhibit distinct cardiac associations: NLR with repolarization, MPV/PLR with conduction, and CRP/Albumin with remodeling. The findings suggest the promise of biomarkers in the identification of IBD patients at risk of subclinical cardiac involvement and the requirement for longer-term validation.\u003c/p\u003e","manuscriptTitle":"Association of Inflammatory Biomarkers with Subclinical Cardiac Dysfunction in Inflammatory Bowel Disease: Roles of NLR, PLR, CRP/Alb, and MPV","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 17:53:38","doi":"10.21203/rs.3.rs-8244067/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-20T19:07:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T12:07:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275072780614539196741882608778641426797","date":"2026-02-14T09:58:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T12:02:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8226660481456091778301509667848635627","date":"2026-02-09T10:48:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-09T09:38:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-09T05:40:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-23T11:48:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-23T06:48:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-12-23T06:39:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8aee8ac1-9e3a-44bf-afc5-4d15a0fa12d9","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-26T09:08:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 17:53:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8244067","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8244067","identity":"rs-8244067","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}