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Detectable Laboratory Abnormality Is Present up to 12 Months Prior to Diagnosis in Patients with Crohn’s Disease

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Abstract

Background and Aims

Patients with inflammatory bowel disease (IBD) often have subjective symptoms for months or years prior to their diagnosis. Blood tests taken prior to diagnosis may provide objective evidence of duration of pre-diagnosis disease. We aim to describe the pre-diagnosis laboratory pattern of patients with IBD.

Methods

A total of 838 patients diagnosed with IBD between 01/01/1996 and 01/03/2014, with pre-diagnosis laboratory testing available, contributed data for analysis. C-reactive protein, erythrocyte sedimentation rate, hemoglobin level, mean cell volume (MCV) platelet count, white blood cell count, neutrophil count, albumin level, ferritin level, serum iron level, alanine transaminase level, and fecal calprotectin were examined in the 24 months leading up to diagnosis and compared to baseline data taken between 24 and 36 months prior to diagnosis.

Results

For patients with Crohn’s disease, a significant drop in serum albumin and MCV levels and a significant rise in platelet count were observed between 115 and 385 days prior to diagnosis (p < 0.01, two-tailed t test). For patients with ulcerative colitis, a significant change in albumin level, MCV, hemoglobin level, platelet count, and serum iron level was observed at diagnosis (p < 0.01, two-tailed t test) but was not detectable before.

Conclusions

These data provide objective evidence of duration of delay between disease onset and diagnosis in a cohort of patients with IBD. Expediting diagnostic testing in patients presenting with symptoms consistent with IBD, who also have abnormal laboratory results, may reduce diagnostic delay, speed access to therapy, and improve clinical outcomes.

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Abbreviations

ALT:

Alanine transaminase

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

IBD:

Inflammatory bowel diseases

MCV:

Mean cell volume

WBC:

White blood cell count

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Funding

This work was supported by peer-reviewed grants from the National Health and Medical Research Council (Australia) and the Royal Brisbane and Women’s Hospital Foundation.

Author information

Authors and Affiliations

  1. Inflammatory Bowel Diseases Research Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia

    James R. Irwin, Emma Ferguson, Lisa A. Simms, Katherine Hanigan & Graham Radford-Smith

  2. Department of Gastroenterology and Hepatology, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    James R. Irwin & Graham Radford-Smith

  3. School of Medicine, The University of Queensland, Brisbane, Australia

    James R. Irwin, Emma Ferguson & Graham Radford-Smith

  4. CSIRO Health and Biosecurity/Australian E-Health Research Centre, Brisbane, Australia

    James D. Doecke

  5. Department of Immunology, Sullivan and Nicolaides Pathology, Brisbane, Australia

    Daman Langguth & Ashley Arnott

  6. Palmerston North Hospital, 50 Ruahine Street, Palmerston North, 4442, New Zealand

    James R. Irwin

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  1. James R. Irwin
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  2. Emma Ferguson
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Contributions

JRI performed data collection, performed statistical analysis, drafted the manuscript, and was involved in the final review of the manuscript. GRS performed data collection and was involved in the final review of the manuscript. JDD performed statistical analysis and was involved in the final review of the manuscript. EF, KH, LAS, AA, and DL performed data collection and were involved in review of the manuscript.

Corresponding author

Correspondence to James R. Irwin.

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Conflict of interest

GRS has worked on advisory boards for and received consulting fees from Abbvie, Janssen, Ferring, Takeda, and Amgen. JRI, EF, KH, LAS, JD, DL, and AA have no conflict of interest to declare.

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Irwin, J.R., Ferguson, E., Simms, L.A. et al. Detectable Laboratory Abnormality Is Present up to 12 Months Prior to Diagnosis in Patients with Crohn’s Disease. Dig Dis Sci 64, 503–517 (2019). https://doi.org/10.1007/s10620-018-5357-0

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  • DOI: https://doi.org/10.1007/s10620-018-5357-0

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