Published online Jan 7, 2027. doi: 10.3748/wjg.122855
Revised: June 13, 2026
Accepted: July 2, 2026
Published online: January 7, 2027
Processing time: 185 Days and 17.6 Hours
A substantial proportion of patients with ulcerative colitis experience clinical relapse despite achieving endoscopic improvement. While it is known that serum total cholesterol (TC) levels fluctuate with inflammatory activity, the clinical significance of longitudinal changes in serum TC after endoscopic improvement remains unclear.
To investigate longitudinal serum TC trajectories after endoscopic improvement and their association with subsequent clinical relapse.
This single-center retrospective cohort study at a tertiary hospital included 452 patients with ulcerative colitis who achieved endoscopic improvement (Mayo endoscopic subscore, 0-1) between 2018 and 2019. Patients were observed until clinical relapse or the last outpatient visit. Relapse was defined as worsening symptoms requiring systemic corticosteroids or step-up medical therapy. Serial serum TC levels were analyzed using generalized estimating equations, time-varying Cox models, and 1-year, 2-year, and 3-year landmark analyses.
During a median follow-up of 67.3 months, 199 patients (44%) experienced clinical relapse. Baseline serum TC levels at endoscopic improvement were similar between the groups; however, the longitudinal patterns differed significantly, showing a progressive increase in patients who later relapsed (time-by-group interaction, P = 0.002). In the time-varying Cox model, each 1 mmol/L increase in updated TC was associated with a higher hazard of clinical relapse (adjusted hazard ratio = 1.31; 95%CI: 1.03-1.66; P = 0.026). Supportive landmark analyses showed that higher maximal TC levels before each landmark were associated with subsequent clinical relapse.
Longitudinal serum TC patterns after endoscopic improvement are associated with the risk of subsequent clinical relapse and may provide complementary information regarding relapse risk.
Core Tip: Most studies link serum lipid levels, including total cholesterol (TC), to concurrent inflammatory activity, not to changes after endoscopic improvement. In this retrospective cohort of patients with ulcerative colitis, baseline serum TC did not distinguish outcomes, whereas exploratory trajectory analysis showed divergent serial TC patterns according to subsequent clinical relapse status. In the time-varying Cox model, each 1 mmol/L increase in updated TC was associated with a 1.31-fold higher hazard of clinical relapse. Supportive landmark analyses showed similar associations using maximal TC. Serial serum TC patterns may provide complementary information associated with relapse risk.