IS CRP – ALBUMIN RATIO A BETTER DIAGNOSTIC BIOMARKER THAN NEUTROPHIL – LYMPHOCYTE RATIO IN RECURRENT APHTHOUS STOMATITIS? – A CROSSSECTIONAL STUDY

Background: Painful, recurrent, round or ovoid ulcers on the oral mucosa are a defining feature of recurrent aphthous stomatitis (RAS). C-reactive protein to albumin ratio (CAR) is a developing measure for predicting inflammation that captures the intensity of inflammatory reactions. On the other hand, neutrophil-to-lymphocyte ratio (NLR), which combines the functions of innate and adaptive immunity has been proven as a biomarker that is elevated in RAS cases. Aim: To analyze the diagnostic role of CAR and NLR ratio as biomarkers in patients with aphthous ulceration by comparing with healthy controls. Materials and Methods: This cross-sectional study was conducted on 50 patients clinically diagnosed with recurrent aphthous stomatitis and 50 patients without the oral ulceration. Blood samples were obtained from all participants to study the levels of inflammatory markers. Complete blood count was obtained to evaluate neutrophils, lymphocyte, C-reactive protein (CRP) and albumin levels. CAR and NLR values were calculated and compared between cases and control to elicit possible association with RAS. Results: The neutrophil-lymphocyte ratio in cases was approximately 1.24 times higher than in controls. CRPalbumin ratio is about 6.75 times higher in cases than in controls. These differences were found to be highly significant statistically. The Receiver operating characteristic (ROC) curve analysis suggests that CRP-Albumin ratio is a more effective diagnostic marker for identifying RAS as indicated by the better sensitivity (88.0) and specificity (84.0) compared to that of NLR (sensitivity = 66.0, specificity = 64.0).

Conclusion: This study claims to be among the first to compare the diagnostic accuracy of CAR to that of NLR in RAS, in the Indian population. Given its strong diagnostic performance, CAR could be prioritized as a primary marker in the clinical assessment of recurrent aphthous stomatitis. Although the neutrophil-tolymphocyte ratio (NLR) also shows statistical significance and reasonable discriminatory power, it may be more suitable as a complementary marker alongside CAR in evaluating RAS.