Abstract

Background and Aim: Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease (IBD) associated with increased susceptibility to enteric infections, which may mimic or exacerbate disease flares. The C-reactive protein (CRP)-to-albumin ratio (CAR) has emerged as a simple indicator of systemic inflammation in UC. This study aimed to assess the prevalence of stool infections in active UC and to further evaluate CAR as a potential predictive marker. Methods: This retrospective study included 42 patients with active UC (Mayo score ≥ 6) from April 2024 to February 2025. Stool samples were analyzed using multiplex polymerase chain reaction (PCR) for 25 bacterial, viral, and parasitic pathogens. Serum CRP and albumin levels were measured to calculate the CAR. Patients were categorized as infected or non-infected. Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate CAR predictive performance. Results: Enteric infections were identified in 35.7% of patients, with Escherichia coli species predominating. CAR was significantly higher in infected than in non-infected patients [0.21 (0.02–0.62) vs. 0.06 (0.02–0.15), p = 0.028]. CAR was significantly associated with enteric infection in logistic regression analysis (OR = 240.0, 95% CI 2.7–21,555.6; p = 0.017). ROC analysis yielded an AUC of 0.706, with a cut-off value of 0.669 providing 100% specificity and 40% sensitivity. Conclusion: Enteric infections are prevalent in patients with active UC. CAR may serve as a simple, rapid, and accessible adjunctive marker to identify patients who warrant further evaluation for enteric infection. Thus, it may aid in differentiating UC flares from superimposed infection.

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