Abstract
Inflammation may affect many routinely available parameters of iron homeostasis. Thus, the recognition of iron deficiency in inflammatory bowel disease (IBD) remains a diagnostic challenge in a clinical routine. The aim of the study was to detect the most efficient marker of iron deficiency in IBD children. In a group of 75 IBD children, we evaluated the sensitivity, specificity, accuracy, and positive and negative predictive values of erythrocytes’ indices, including MCV, MCH, MCHC and RDW, and biochemical markers, including iron, transferrin, sTfR and sTfR/log ferritin, for identifying iron deficiency. Receiver operating characteristic (ROC) analysis was used to compare the ability of these parameters to detect iron deficiency. The best predictors of iron deficiency were sTfR/log ferritin, with accuracy 0.86, sensitivity 0.98, specificity 0.63, positive predictive value 0.83 and negative predictive value 0.94, and sTfR, with accuracy 0.77, sensitivity 0.82, specificity 0.67, positive predictive value 0.82 and negative predictive value 0.67. Moreover, sTfR/log ferritin exhibited the largest area under ROC (0.922), followed by sTfR (0.755) and MCH (0.720). The sTfR/log ferritin index appears to be the most efficient marker of iron depletion in pediatric IBD, and it may give an added value in the management of IBD patients.
Highlights
Iron deficiency is a widespread complication of inflammatory bowel disease (IBD) which may affect 36% to 90% of IBD patients, depending on the studied population and applied criteria of iron deficiency [1]
It has to be highlighted that increased hepcidin level in IBD is responsible for iron retention in enterocytes and macrophages that leads to inhibition of iron turnover, hypoferremia and iron-restricted erythropoiesis [3,5]
The study group consisted of 75 IBD patients, including 46 (61.3%) children with ulcerative colitis and 29 (38.7%) children with Crohn’s disease
Summary
Iron deficiency is a widespread complication of inflammatory bowel disease (IBD) which may affect 36% to 90% of IBD patients, depending on the studied population and applied criteria of iron deficiency [1]. It has been found that, at IBD onset, about 90% of children with Crohn’s disease and 95%. Of children with ulcerative colitis suffered from depleted iron stores. A two-year follow-up analysis showed that iron deficiency was still present in 70% of children with Crohn’s disease and 65%. Of children with ulcerative colitis [2]. It appears that, in children with IBD, iron deficiency may not be identified properly or not treated sufficiently. There are several possible causes of iron depletion among IBD patients, including loss of blood from the gastrointestinal tract, limited iron supply and impaired iron absorption [3,4]. It has to be highlighted that increased hepcidin level in IBD is responsible for iron retention in enterocytes and macrophages that leads to inhibition of iron turnover, hypoferremia and iron-restricted erythropoiesis [3,5]
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