Diagnostic Value of Correlation Between Canine Chronic Enteropathy Clinical Activity Index (CCECAI) and Selected Hematological and Immunological Biomarkers in Dogs with Chronic Enteropathy: A Systematic Meta-Analysis

Abstract

C-reactive protein (CRP) level, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) have been proposed as biomarkers that reflect disease severity in canine chronic enteropathies. Their correlation with the Canine Chronic Enteropathy Clinical Activity Index (CCECAI) remains unclear. The objective of the present meta-analysis was to assess the correlation between CCECAI and hematological and immunological markers in dogs with CIE. A meta-analysis was conducted to evaluate the correlation of CRP, PLR, and NLR with CCECAI as a diagnostic marker. The PRISMA guidelines were followed to accomplish this procedure. Pooled correlation coefficients were calculated using Fisher’s Z-transformation under random effects models. Heterogeneity and publication bias were examined using standard procedures for the meta-analysis. Eleven studies were found to be fit: five for CRP, four for NLR, and four for PLR. The pooled correlation for CRP level was 0.229 (95% CI: 0.143–0.311, p < 0.001), with consistent findings across studies (I2 = 0%). PLR demonstrated a moderate correlation (pooled r = 0.381, 95% CI: 0.238–0.508, p < 0.001; I2 = 41%), while NLR showed a slightly stronger correlation (pooled r = 0.410, 95% CI: 0.286–0.521, p < 0.001) but with substantial heterogeneity (I2 = 68%). Publication bias analyses indicated modest asymmetry for CRP and PLR, with Egger’s regression significant for both, whereas the NLR showed no clear evidence of bias. Trim-and-fill adjustments slightly attenuated the pooled estimates but did not alter the statistical significance. In conclusion, the correlation between CCECAI and NLR is the most promising biomarker, followed closely by PLR, whereas CRP has a weaker predictive value. The correlation between CCECAI and each of NLR and PLR may provide rapid and reliable diagnostic information about CIE in dogs.