P0458 The burden, risk factors and laboratory evaluation of anemia in patients with Inflammatory Bowel Disease
Authors: Foteinogiannopoulou K , Orfanoudaki E , Theodoraki E , Gkiaouraki E , Niniraki M , Prinari I , Kalyvianaki K , Kampa M , Koutroubakis I 
Published: January 2025

Abstract

Background
Anemia is the most common extraintestinal manifestation in inflammatory bowel disease (IBD) (1). The laboratory evaluation and determination of anemia in IBD remains challenging (2). The aim of this study was to evaluate the burden, risk factors and types of anemia in IBD patients in Crete.

Methods
This is a cross sectional study where consecutive IBD patients were included. Demographic, clinical and laboratory data [Hemoglobin (Hgb), Ferritin (Fer)] were recorded (based on an updated IBD registry) while serums of consecutive IBD patients were collected and Soluble transferrin receptor (sTFR), sTFR Index and Hepcidin (Hepc) were measured.

Results
A total of 151 [69 (45.7%) females, 90 (59.6%) with Crohn’s Disease (CD), 34 (22.5%) anemic and 117 (77.5%) non-anemic] were included. Anemic patients were found to be less frequently smokers (P=0.0182), to have shorter IBD duration (P=0.0112) and more often active disease (P=0.0270) compared to non-anemic IBD patients. No other significant differences in clinical and demographic characteristics were found. In addition, they had significantly lower Hgb, MCV [11.6 (10.7-12.4) vs 14.1 (13.3-15), 80.3 (78.4-85.8) vs 90.6 (86.5-94.5) respectively, both P&lt; 0.0001], Ferritin [35.5 (8.2-69) vs 60 (33-112), P=0.0164], and higher RDW, ESR, sTFR [16.2 (14.9- 17.8) vs 14.2 (13.5-15), 27 (12.5-45) vs 9.5 (8.5-15), 1.85 (1.33-2.67) vs 1.22 (1.02-1.52) respectively, all P&lt;0.0001], CRP [0.6 (0.2-2.5) vs 0.3 (0.1-2), P=0.0028] and sTFR Index [1.14 (0.75-3.10) vs 0.68 (0.55-1.03), P=0.0002)]. In terms of risk factors for anemia development younger age (OR 1.04, CI95% 1.02-1.07), smoking (OR 0.22, CI95% 0.06-0.80) and higher ESR (OR 1.04, CI95% 1.02-1.07) were found to be significant in the multivariate analysis. From the anemic patients (N=34), 17 had iron deficiency (IDA) and the rest non-IDA (anemia of chronic disease and mixed). Patients with IDA compared to non-IDA had significantly higher sTFR and sTFR Index while no difference was found in Hepc (Table 1). sTFR &gt;1.68 mg/l had sensitivity of 76.5% and specificity of 73.3% while sTFR Index &gt;1.1365 has sensitivity 82.4% and specificity 86.7% for IDA diagnosis suggesting that sTFR Index is the most accurate index for IDA diagnosis in IBD patients (Figure 1).

Conclusion
One out of 5 IBD patients have anemia in our cohort. Risk factors for anemia are the age, smoking status and ESR. sTFR and especially sTFR Index could be useful for true IDA diagnosis in IBD patients in the presence of chronic inflammation.

References
1.Kulnigg S, Gasche C. Systematic review: managing anemia in Crohn’s disease. Aliment Pharmacol Ther. 2006;24:1507–232
2.Gordon H, Burisch J, Ellul P, Karmiris K, Katsanos K, Allocca M, Bamias G, Barreiro-de Acosta M, Braithwaite T, Greuter T, Harwood C, Juillerat P, Lobaton T, Müller-Ladner U, Noor N, Pellino G, Savarino E, Schramm C, Soriano A, Michael Stein J, Uzzan M, van Rheenen PF, Vavricka SR, Vecchi M, Zuily S, Kucharzik T. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2024 Jan 27;18(1):1-37.