Can red blood cell distribution width (RDW) predict clinical and endoscopic activity in ulcerative colitis patients?

Hüseyin Pülat; Serkan Yalaki

doi:10.28982/josam.712289

Authors

Hüseyin Pülat Mersin City Training and Research Hospital https://orcid.org/0000-0003-0635-3387
Serkan Yalaki https://orcid.org/0000-0001-8137-0924

DOI:

https://doi.org/10.28982/josam.712289

Keywords:

Ulcerative colitis, Endoscopic activity indexes, Clinical activity index, RDW

Abstract

Aim: Classification of ulcerative colitis (UC) according to disease activity and severity is important in clinical practice for it determines the management of the patient. In this study, we aimed to investigate the relationship between red blood cell distribution width (RDW) and clinical activity index (CAI) in UC patients as well as endoscopic activity indexes (EIA) that determine disease severity relative to mucosal disease.
Methods: This research was planned as a case-control study. Ninety-nine patients diagnosed with UC were divided an active disease group and a remission group according to their clinical and endoscopic findings. Age and gender-matched control groups were formed from 56 individuals with normal colonoscopic findings.
Results: Serum RDW levels were significantly higher in the UC group (P<0.001). In post-hoc comparisons, a statistically significant difference was observed between the control group and active disease groups (P<0.001). However, RDW values did not significantly predict clinical and endoscopic activity in either the active disease or the remission groups (P=0.05 and P=0.09, respectively). In predicting clinical and endoscopic activity indices, the cut-off values of RDW were 14.25 (66% sensitivity and 72% specificity) and 13.75 (64% sensitivity and 62% specificity), respectively.
Conclusion: This study showed that RDW can be used as a marker for disease activity in ulcerative colitis, but it did not show the same efficacy in remission and active disease distinction.

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References

Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019 Dec;68(Suppl 3): s1-s106. doi:0.1136/gutjnl-2019-3184841

Caprilli R, Viscido A, Latella G. Current management of severe ulcerative colitis. Nat Clin Pract Gastroenterol Hepatol. 2007 Feb;4(2):92-101. doi: 10.1038/ncpgasthep0687.

Lok KH, Ng CH, Hung HG, Li KF, Li KK, Szeto ML. Correlation of serum biomarkers with clinical severity and mucosal inflammation in Chinese ulcerative colitis patients. J Dig Dis. 2008 Nov;9(4):219-24. doi: 10.1111/j.1751-2980.2008.00350.x.

Hassan EA, Ramadan HK, Ismael AA, Mohamed KF, El-Attar MM, Alhelali I. Noninvasive biomarkers as surrogate predictors of clinical and endoscopic remission after infliximab induction in patients with refractory ulcerative colitis. Saudi J Gastroenterol. 2017 Jul-Aug;23(4):238-245. doi: 10.4103/sjg.SJG_599_16.

Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut. 2006 Mar;55(3):426-31. doi: 10.1136/gut.2005.069476.

Karnad A, Poskitt TR. The automated complete blood cell count. Use of the red blood cell volume distribution width and mean platelet volume in evaluating anemia and thrombocytopenia. Arch Intern Med. 1985 Jul;145(7):1270-2. doi: 10.1001/archinte.145.7.1270.

Goyal H, Lippi G, Gjymishka A, John B, Chhabra R, May E. Prognostic significance of red blood cell distribution width in gastrointestinal disorders. World J Gastroenterol. 2017 Jul 21;23(27):4879-4891. Doi: 10.3748/wjg.v23.i27.4879.

Hammarsten O, Jacobsson S, Fu M. Red cell distribution width in chronic heart failure: a new independent marker for prognosis? Eur J Heart Fail. 2010 Mar;12(3):213-4. doi: 10.1093/eurjhf/hfp208.

Chen GP, Huang Y, Yang X, Feng JF. A Nomogram to Predict Prognostic Value of Red Cell Distribution Width in Patients with Esophageal Cancer. Mediators Inflamm. 2015:2015:854670. doi: 10.1155/2015/854670.

Celikhisar H, Dasdemir Ilkhan. Comparison of erythrocyte distribution width, mean platelet volume and platelet distribution width in patients with obstructive sleep apnea syndrome. J Surg Med. 2019;3(10):734-9. doi: 10.28982/josam.622377

Cakal B, Akoz AG, Ustundag Y, Yalinkilic M, Ulker A, Ankarali H. Red cell distribution width for assessment of activity of inflammatory bowel disease. Dig Dis Sci. 2009 Apr;54(4):842-7. doi: 10.1007/s10620-008-0436-2.

Song CS, Park DI, Yoon MY, Seok HS, Park JH, Kim HJ et al. Association between red cell distribution width and disease activity in patients with inflammatory bowel disease. Dig Dis Sci. 2012 Apr;57(4):1033-8. Doi: 10.1007/s10620-011-1978-2. Epub 2011 Dec 7.

Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006 Jun;55(6):749-53. doi: 10.1136/gut.2005.082909.

Feagan BG, Greenberg GR, Wild G, Fedorak RN, Paré P, McDonald JW et al. Treatment of ulcerative colitis with a humanized antibody to the alpha4beta7 integrin. N Engl J Med. 2005 Jun 16;352(24):2499-507. doi: 10.1056/NEJMoa042982.

Lee JS, Kim ES, Moon W. Chronological Review of Endoscopic Indices in Inflammatory Bowel Disease. Clin Endosc. 2019 Mar;52(2):129-36. doi: 10.5946/ce.2018.042.

Rosenberg L, Lawlor GO, Zenlea T, Goldsmith JD, Gifford A, Falchuk KR, et al. Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis. 2013 Mar-Apr;19(4):779-84. doi: 10.1097/MIB.0b013e3182802b0e.

D'Haens G, Sandborn WJ, Feagan BG, Geboes K, Hanauer SB, Irvine EJ, et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology. 2007 Feb;132(2):763-86. doi: 10.1053/j.gastro.2006.12.038.

Osada T, Ohkusa T, Okayasu I, Yoshida T, Hirai S, Beppu K, et al. Correlations among total colonoscopic findings, clinical symptoms, and laboratory markers in ulcerative colitis. J Gastroenterol Hepatol. 2008 Dec;23 Suppl 2:S262-7. doi: 10.1111/j.1440-1746.2008.05413.x.

Yoon JY, Park SJ, Hong SP, Kim TI, Kim WH, Cheon JH. Correlations of C-reactive protein levels and erythrocyte sedimentation rates with endoscopic activity indices in patients with ulcerative colitis. Dig Dis Sci. 2014 Apr;59(4):829-37. doi: 10.1007/s10620-013-2907-3. Epub 2013 Dec 19.

Karoui S, Laz S, Serghini M, Bibani N, Boubaker J, Filali A. Correlation of C-reactive protein with clinical and endoscopic activity in patients with ulcerative colitis. Dig Dis Sci. 2011 Jun;56(6):1801-5. doi: 10.1007/s10620-010-1496-7.

Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007 Jul 3;50(1):40-7. doi: 10.1016/j.jacc.2007.02.067.

Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005 Mar 10;352(10):1011-23. doi: 10.1056/NEJMra041809.

Yeşil A, Senateş E, Bayoğlu IV, Erdem ED, Demirtunç R, Kurdaş Övünç AO. Red cell distribution width: a novel marker of activity in inflammatory bowel disease. Gut Liver. 2011 Dec;5(4):460-7. doi: 10.5009/gnl.2011.5.4.460.

Oustamanolakis P, Koutroubakis IE, Messaritakis I, Kefalogiannis G, Niniraki M, Kouroumalis EA. Measurement of reticulocyte and red blood cell indices in the evaluation of anemia in inflammatory bowel disease. J Crohns Colitis. 2011 Aug;5(4):295-300. doi: 10.1016/j.crohns.2011.02.002.

Ipek S, Cekic C, Alper E, Coban E, Eliacik E, Arabul M et al. Can red cell distribution width be a marker of disease activity in ulcerative colitis? Int J Clin Exp Med. 2015 Aug 15;8(8):13848-53.