Background: Ulcerative colitis (UC) is a chronic inflammatory condition characterized by periods of activity and remission. Identifying accessible biomarkers that correlate with disease activity could aid in disease monitoring. This study evaluated the potential of lipid profile components as biomarkers for disease activity in patients with severe UC.

Methods: A retrospective analysis was conducted on 220 patients diagnosed with severe UC. Fasting lipid profiles—including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs)—were compared between patients in active and remission phases. Correlation analyses were performed between lipid values and C-reactive protein (CRP) levels as well as Mayo scores. Logistic regression and ROC curve analysis assessed the predictive performance of lipid parameters for active disease.

Results: No statistically significant differences were found in TC, LDL-C, HDL-C, or TG levels between patients with active UC and those in remission (all p-values > 0.39). Correlations between lipid markers and CRP or Mayo scores were weak and nonsignificant (HDL-C and CRP: r = 0.01, p = 0.87; TGs and CRP: r = –0.05, p = 0.63). None of the lipid components were independent predictors of disease activity in multivariate analysis. The combined lipid model yielded a modest discriminative performance (AUC = 0.58).

Conclusion: Serum lipid profiles did not significantly differ between active and remission states of severe UC and showed limited utility as standalone biomarkers of disease activity. Further prospective studies are warranted to explore alternative noninvasive markers for monitoring UC severity.