The Potential of High-Density Lipoprotein as a Predictive Biomarker for Infliximab Efficacy in Crohn’s Disease

Keke Tang,1,2,* Ziheng Peng,1,2,* Duo Xu,1,2 Yong Li,1,2 Xiaowei Liu,1– 3 Guanghui Lian,1– 3 Yu Peng1– 3 1Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 2Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 3Research Center for Geriatric Disorder, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yu Peng, Email [email protected] Guanghui Lian, Email [email protected]: To assess whether baseline serum high density lipoprotein (HDL) levels predict the effectiveness of infliximab in patients with Crohn’s disease (CD).Methods: This was a retrospective single-center study evaluating CD patients baseline data and effectiveness of infliximab at the Xiangya Hospital, Central South University, between January 2016 and September 2021. The primary endpoint was composite adverse outcome during 52 weeks, defined as clinical activity, changes in treatment, surgical treatment, or unexpected readmission.Results: Among the 166 enrolled patients, 37 (22.3%) experienced adverse events within the 52-week follow-up period. HDL was identified as a predictor of adverse outcomes at 52 weeks (AUC 0.661, p < 0.05), with an optimal cut-off value of 0.85. Patients with higher HDL levels not only exhibited elevated total cholesterol but were also associated with better nutritional status and lower inflammatory burden. HDL was negatively correlated with white blood cell count and C-reactive protein, and positively correlated with albumin level (p < 0.05). Baseline HDL level was an independent risk factor for adverse events within 52 weeks in CD patients treated with infliximab (p = 0.022). Moreover, the high-HDL group demonstrated a significantly lower risk of developing adverse events (p = 0.0017).Conclusion: The identification of HDL as an independent risk factor for 52-week adverse events in infliximab-treated CD patients suggests its potential utility as a predictive biomarker.Trial Registration: The study adhered to the Declaration of Helsinki. All participants provided written informed consent, and the study was approved by the Ethics Committee of Xiangya Hospital, Central South University with approval No. 202108158.Plain Language Summary: Given the variable therapeutic response to IFX among patients, there exists a critical need for reliable biomarkers to monitor treatment effectiveness and guide individualized clinical decision-making.HDL demonstrated significant inverse correlations with both CRP levels and WBC counts, while showing a positive association with serum albumin concentrations. Multivariate analysis identified HDL as an independent predictor of adverse events within 52 weeks following infliximab therapy in CD patients.HDL measurement represents a promising prognostic tool for IFX-treated CD patients, offering three distinct clinical benefits: first, broader patient applicability compared to existing markers; second, enhanced utility in routine clinical practice; and third, potential cost-saving implications for therapeutic management.Keywords: high-density lipoprotein, infliximab, Crohn’s disease, effectiveness, biomarker