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Digestive Diseases and Sciences

, Volume 57, Issue 4, pp 1033–1038 | Cite as

Association Between Red Cell Distribution Width and Disease Activity in Patients with Inflammatory Bowel Disease

  • Chang Seok Song
  • Dong Il Park
  • Min Yong Yoon
  • Hyo Sun Seok
  • Jung Ho Park
  • Hong Joo Kim
  • Yong Kyun Cho
  • Chong Il Sohn
  • Woo Kyu Jeon
  • Byung Ik Kim
Original Article

Abstract

Background

Recent studies have suggested that a higher red blood cell distribution width (RDW) is associated with disease activity in patients with inflammatory bowel disease (IBD). However, the RDW in IBD patients without anemia has not been investigated.

Aim

This study aimed to determine whether or not RDW could be used for the assessment of disease activity in IBD patients with and without anemia.

Methods

The serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), hemoglobin concentration, platelet and white blood cell counts, and RDW were assessed in 221 IBD patients, comprised of 120 patients with ulcerative colitis (UC) and 101 patients with Crohn’s disease (CD). Disease activity was determined for UC and CD with the Mayo score and the Crohn’s disease activity index, respectively.

Results

The CRP level, ESR, hemoglobin concentration, hematocrit, and RDW increased according to disease activity in patients with and without anemia (all P < 0.05). Multivariate analysis demonstrated that RDW was the best independent indicator for predicting disease activity in CD patients without anemia [odd ratios (OR), 1.702; 95% confidence interval (CI), 1.185–2.445; P = 0.004] and UC patients without anemia (OR, 4.921; 95% CI, 2.281–10.615; P < 0.001). Also, ROC curve analysis showed the RDW to be the most significant indicator of non-anemic active IBD [area under curve (AUC) in CD, 0.852, P < 0.001; AUC in UC, 0.827, P < 0.001].

Conclusion

The association between increased RDW and active IBD was evident in IBD patients with and without anemia.

Keywords

Inflammatory bowel disease Red cell distribution width Ulcerative colitis Crohn’s disease 

Notes

Acknowledgment

This paper was supported by Songcheon Research Fund, Sungkyunkwan University, 2011.

References

  1. 1.
    Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002;347:417–429. doi: 10.1056/NEJMra020831.Google Scholar
  2. 2.
    Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut. 2006;55:426–431. doi: 10.1136/gut.2005.069476.Google Scholar
  3. 3.
    Rudolph WG, Uthoff SM, McAuliffe TL, Goode ET, Petras RE, Galandiuk S. Indeterminate colitis: the real story. Dis Colon Rectum. 2002;45:1528–1534. doi: 10.1097/01.DCR.0000034051.08192.A2.
  4. 4.
    Abdelrazeq AS, Wilson TR, Leitch DL, Lund JN, Leveson SH. Ileitis in ulcerative colitis: is it a backwash? Dis Colon Rectum. 2005;48:2038–2046. doi: 10.1007/s10350-005-0160-3.Google Scholar
  5. 5.
    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;145:1270–1272.Google Scholar
  6. 6.
    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;12:213–214. doi: 10.1093/eurjhf/hfp208.Google Scholar
  7. 7.
    Anderson JL, Ronnow BS, Horne BD, et al. Usefulness of a complete blood count-derived risk score to predict incident mortality in patients with suspected cardiovascular disease. Am J Cardiol. 2007;99:169–174. doi: 10.1016/j.amjcard.2006.08.015.Google Scholar
  8. 8.
    Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci. 2009;277:103–108. doi: 10.1016/j.jns.2008.10.024.Google Scholar
  9. 9.
    Brusco G, Di Stefano M, Corazza GR. Increased red cell distribution width and coeliac disease. Dig Liver Dis. 2000;32:128–130. doi: S1590-8658(00)80399-0.
  10. 10.
    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;54:842–847. doi: 10.1007/s10620-008-0436-2.Google Scholar
  11. 11.
    Clarke K, Sagunarthy R, Kansal S. RDW as an additional marker in inflammatory bowel disease/undifferentiated colitis. Dig Dis Sci. 2008;53:2521–2523. doi: 10.1007/s10620-007-0176-8.
  12. 12.
    Stange EF, Travis SP, Vermeire S, et al. European evidence-based Consensus on the diagnosis and management of ulcerative colitis: Definitions and diagnosis. J Crohns Colitis. 2008;2:1–23. doi: 10.1016/j.crohns.2007.11.001.Google Scholar
  13. 13.
    Stange EF, Travis SP, Vermeire S, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut. 2006;55:i1–i15. doi: 10.1136/gut.2005.081950a.Google Scholar
  14. 14.
    Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317:1625–1629. doi: 10.1056/NEJM198712243172603.
  15. 15.
    D’Haens G, Sandborn WJ, Feagan BG, et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology. 2007;132:763–786. doi: 10.1053/j.gastro.2006.12.038.Google Scholar
  16. 16.
    Felker GM, Allen LA, Pocock SJ, 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;50:40–47. doi: 10.1016/j.jacc.2007.02.067.
  17. 17.
    Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008;117:163–168. doi: 10.1161/CIRCULATIONAHA.107.727545.Google Scholar
  18. 18.
    Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352:1011–1023. doi: 10.1056/NEJMra041809.Google Scholar
  19. 19.
    Papadaki HA, Kritikos HD, Valatas V, Boumpas DT, Eliopoulos GD. Anemia of chronic disease in rheumatoid arthritis is associated with increased apoptosis of bone marrow erythroid cells: improvement following anti-tumor necrosis factor-alpha antibody therapy. Blood. 2002;100:474–482. doi: 10.1182/blood-2002-01-0136.Google Scholar
  20. 20.
    Forhecz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohaszka Z, Janoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009;158:659–666. doi: 10.1016/j.ahj.2009.07.024.
  21. 21.
    Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009;133:628–632. doi: 10.1043/1543-2165-133.4.628.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Chang Seok Song
    • 1
  • Dong Il Park
    • 1
  • Min Yong Yoon
    • 1
  • Hyo Sun Seok
    • 1
  • Jung Ho Park
    • 1
  • Hong Joo Kim
    • 1
  • Yong Kyun Cho
    • 1
  • Chong Il Sohn
    • 1
  • Woo Kyu Jeon
    • 1
  • Byung Ik Kim
    • 1
  1. 1.Department of Internal MedicineKangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulKorea

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