Clinical value of combined serum TNF-a, IL-10, and fecal calprotectin for assessing disease activity and guiding individualized management in inflammatory bowel disease

Background: This study evaluated the clinical value of ackground: combined serum tumor necrosis factor-a (TNF-a), interleukin-10 (IL-10), and fecal calprotectin (FC) measurements for assessing inflammatory bowel disease (IBD) activity and supporting individualized management. Methods: In this retrospective comparative cohort study, 140 hospitalized patients with IBD were included, comprising 68 patients managed using an individualized pathway guided by TNF-a, IL-10, and FC measurements and 72 patients receiving routine care. Biomarker levels, disease activity indices, clinical outcomes, complications, and 6-month follow-up data were analyzed. Receiver operating characteristic analysis was used to assess the performance of the biomarkers for identifying active IBD, and multivariate logistic regression was performed to evaluate their associations with adverse outcomes. Results: Combined detection of TNF-a, IL-10, and FC showed high discriminatory performance for active IBD, with an area under the curve of 0.962 (95% CI: 0.6927– 1.000), sensitivity of 89.7%, specificity of 93.1%, and accuracy of 91.4%. The internally validated nomogram yielded a C-index of 0.922. Compared with routine care, biomarker-guided individualized management was associated with greater improvements in disease activity scores and biomarker profiles, higher mucosal healing (60.3% vs 33.3%), clinical remission (67.6% vs 36.1%), and steroid-free remission (58.8% vs 30.6%) rates, and a lower 6-month recurrence rate (20.6% vs 50.0%). Multivariate analysis identified TNF-a as an independent risk factor for adverse outcomes (OR=2.492, 95% CI: 1.330–4.668, P=0.004), whereas IL-10 was independently protective (OR=0.460, 95% CI: 0.274–0.772, P=0.003). Conclusion: Combined assessment of serum TNF-a, IL10, and FC provides clinically useful information for evaluating IBD activity. These biomarkers may also support risk stratification and individualized management of patients with IBD.