Use of Biomarkers of Inflammation in the Differentiation of Iron Deficiency and Anaemia—Lessons from Inflammatory Bowel Disease
Abstract
:1. Introduction
2. Materials and Methods
2.1. Population Characteristics
2.2. Study Design
2.3. Inflammatory Markers
2.4. Definition of Iron Deficiency and Anaemia
2.5. Statistical Analysis
3. Results
3.1. Study Population
3.2. Iron and Inflammation Markers According to Inflammation Status
3.3. Correlations of the Inflammatory Markers
3.4. Correlations of Serum Inflammatory Markers with Iron Parameters
3.5. Analytical Performance of Inflammatory Markers for the Detection of Active Inflammation
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ACD | anaemia of chronic inflammation |
AGP | α1-acid glycoprotein |
AID | absolute iron deficiency |
APP | acute-phase protein |
AUC | area under curve |
CD | Crohn’s disease |
CRP | C-reactive protein |
ESR | erythrocyte sedimentation rate |
FID | functional iron deficiency |
Hb | haemoglobin |
hsCRP | high-sensitivity C-reactive protein |
IBD | inflammatory bowel disease |
ID | iron deficiency |
IDA | iron deficiency anaemia |
ROC | receiver operating characteristic |
TSAT | transferrin saturation |
UC | ulcerative colitis |
WHO | World Health Organization |
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Crohn’s Disease | Ulcerative Colitis | p1 | p2 | |
---|---|---|---|---|
N (female) | 93 (52) | 77 (41) | 0.759 | - |
Age (years), mean ± SD | 43.5 ± 13.1 | 42.7 ± 13.0 | - | 0.869 |
Disease localisation | ||||
Ulcerative colitis, n (%) | ||||
E1 proctitis | - | 4 (5.2) | - | - |
E2 left-sided colitis | 47 (70.0) | |||
E3 pancolitis | 26 (33.8) | |||
Crohn’s disease, n (%) | ||||
L1 ileum | 43 (46.2) | - | - | - |
L2 colon | 19 (20.4) | |||
L3 ileocolic | 26 (28.0) | |||
L4 perianal | 5 (5.4) | |||
Medication, n (%) | ||||
No treatment | 5 (5.4) | 6 (7.8) | 0.548 | - |
5-ASA | 16 (17.2) | 22 (28.6) | 0.096 | - |
Corticosteroids | 6 (6.5) | 8 (10.4) | 0.404 | - |
Immunomodulators | 5 (5.4) | 1 (1.3) | 0.223 | - |
Biologicals | 62 (66.7) | 41 (53.2) | 0.084 | - |
Laboratory markers, median (min-max) | ||||
Hb (g/dL) | 13.9 (8.2–16.9) | 13.9 (7.0–16.5) | - | 0.820 |
Ferritin (ng/mL) | 85.6 (6.2–1180.0) | 55.2 (5.0–1166.0) | - | 0.094 |
Transferrin (mg/dL) | 254.0 (77.3–416.0) | 272.0 (143.0–404.0) | - | 0.138 |
TSAT (%) | 17.8 (3.5–37.5) | 20.1 (2.8–38.3) | - | 0.852 |
ESR (mm/h) | 6.0 (1.0–67.0) | 7.0 (2.0–79.0) | - | 0.846 |
hsCRP (mg/L) | 3.8 (1–0-83.9) | 2.0 (1.0–112.0) | - | 0.068 |
AGP (µg/mL) | 789.0 (335.8–1610.0) | 709.7 (227.3–1386.9) | - | 0.092 |
Inflammatory (n = 75) (ESR and/or hsCRP and/or AGP over Cut-Off §) | Non-inflammatory (n = 95) (ESR and hsCRP and AGP under Cut-Off §) | p | |
---|---|---|---|
Hb (g/dL) | 13.5 (7.0–16.3) | 14.2 (10.1–16.9) | 0.004 * |
Ferritin (ng/mL) | 85.6 (5.0–1180.0) | 67.7 (7.3–536.0) | 0.177 |
Transferrin (mg/dL) | 257.0 (143.0–407.0) | 266.00 (77.3–416.0) | 0.162 |
TSAT (%) | 14.2 (2.8–36.6) | 24.5 (3.9–38.3) | <0.001 ** |
ESR (mm/h) | 117.0 (2.0–79.0) | 4.0 (1.0–25.0) | <0.001 ** |
hsCRP (mg/L) | 7.7 (1.0–112.0) | 1.2 (1.0–4.9) | <0.001 ** |
AGP (µg/mL) | 976.0 (469.7–1610.0) | 612.2 (227.3–984.9) | <0.001 ** |
Spearman’s Rho | p | ||
---|---|---|---|
ESR (mm/h) vs | Haemoglobin [g/dL] | −0.547 | <0.001 ** |
Ferritin (ng/mL) | 0.163 | 0.033 * | |
Transferrin (mg/dL) | −0.046 | 0.552 | |
TSAT (%) | −0.531 | <0.001 ** | |
hsCRP (mg/L) vs | Haemoglobin [g/dL] | −0.194 | 0.011 * |
Ferritin (ng/mL) | 0.180 | 0.019 * | |
Transferrin (mg/dL) | −0.192 | 0.012 * | |
TSAT (%) | −0.538 | <0.001 ** | |
AGP (µg/mL) vs | Haemoglobin [g/dL] | −0.097 | 0.209 |
Ferritin (ng/mL) | 0.140 | 0.069 | |
Transferrin (mg/dL) | −0.227 | 0.003 * | |
TSAT (%) | −0.338 | <0.001 ** |
AUCROC | Sensitivity | Specificity | p | |
---|---|---|---|---|
ESR | 0.828 (0.766–0.891) | 60.0% | 89.5% | <0.001 ** |
hsCRP | 0.928 (0.887–0.969) | 72.0% | 100.0% | <0.001 ** |
AGP | 0.846 (0.781–0.910) | 62.0% | 92.0% | <0.001 ** |
ESR and hsCRP | 0.932 (0.888–0.976) | 97.0% | 82.0% | <0.001 ** |
ESR and AGP | 0.934 (0.897–0.972) | 89.0% | 85.0% | <0.001 ** |
AGP and hsCRP | 0.955 (0.926–0.985) | 93.0% | 85.0% | <0.001 ** |
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Farrag, K.; Aksan, A.; Ademaj-Kospiri, V.; Leventi, E.; Stein, J. Use of Biomarkers of Inflammation in the Differentiation of Iron Deficiency and Anaemia—Lessons from Inflammatory Bowel Disease. Diagnostics 2024, 14, 1515. https://doi.org/10.3390/diagnostics14141515
Farrag K, Aksan A, Ademaj-Kospiri V, Leventi E, Stein J. Use of Biomarkers of Inflammation in the Differentiation of Iron Deficiency and Anaemia—Lessons from Inflammatory Bowel Disease. Diagnostics. 2024; 14(14):1515. https://doi.org/10.3390/diagnostics14141515
Chicago/Turabian StyleFarrag, Karima, Aysegül Aksan, Valëza Ademaj-Kospiri, Eleni Leventi, and Jürgen Stein. 2024. "Use of Biomarkers of Inflammation in the Differentiation of Iron Deficiency and Anaemia—Lessons from Inflammatory Bowel Disease" Diagnostics 14, no. 14: 1515. https://doi.org/10.3390/diagnostics14141515
APA StyleFarrag, K., Aksan, A., Ademaj-Kospiri, V., Leventi, E., & Stein, J. (2024). Use of Biomarkers of Inflammation in the Differentiation of Iron Deficiency and Anaemia—Lessons from Inflammatory Bowel Disease. Diagnostics, 14(14), 1515. https://doi.org/10.3390/diagnostics14141515