Comparative accuracy of ferritin, transferrin saturation and soluble transferrin receptor for the diagnosis of iron deficiency in inflammatory bowel disease

Abstract

Background:The diagnosis of iron deficiency is based on ferritin and transferrin saturation (TfS) in inflammatory bowel disease (IBD) patients, yet guideline thresholds are not evidence-based. Soluble transferrin receptor (sTfR) is one of the best noninvasive tests in patients with inflammation. Aims:To evaluate the accuracy of ferritin and/or TfS for diagnosing iron deficiency in IBD and identify the optimal thresholds of these parameters using sTfR as reference. Methods: Two hundred and two patients (2072 samples) receiving at least one infusion of biologic (vedolizumab or infliximab) were included. Results: In ulcerative colitis patients with C-reactive protein (CRP) <10 mg/L, optimal iron deficiency diagnostic performances were observed with ferritin and TfS thresholds of 65 µg/L (sensitivity of 0.78 and specificity of 0.76) and 16% (sensitivity of 0.79 and specificity of 0.90), respectively. For ulcerative colitis patients with CRP > 10 mg/L, the thresholds with the best diagnostic performance were 80 µg/L (sensitivity of 0.75 and a specificity of 0.82) for ferritin and 11% for TfS (sensitivity of 0.75 and a specificity of 0.82). There was no added value for combined ferritin and TfS. No ferritin or TfS threshold had good diagnostic performance in Crohn's disease patients (AUC for ferritin was 0.65 (95% CI 0.55-0.75) and the AUC for TfS was 0.70 (95% CI 0.61-0.78). Conclusion: Ferritin and TfS are reliable parameters for iron deficiency diagnosis only in ulcerative colitis patients, at thresholds different from current guidelines. In Crohn's disease patients, sTfR should be used given the poor diagnostic performance of ferritin and TfS. have no conflict of interest to disclose. Silvio Danese has served as a speaker, a consultant and an advisory board member for Schering-Plough, AbbVie, MSD, UCB Pharma, Ferring,

Therapeutic potential of induced iron depletion using iron chelators in Covid-19

“…The level of transferrin saturation, however, can serve as a valuable tool for identifying iron overload. Transferrin's iron-binding sites are estimated to be a proportion of its total number of iron-binding sites ( Daude et al, 2020 Jun ). Ferritin levels higher than 300 µgL -1 are present in about 20% of caucasian men irrespective of age.…”

Body Iron Status Indicators and Inflammation Indicators During Inflammatory Bowel Disease Therapy in Children and Adolescentes

“…Regarding the sTfR, considered one of the best indicators of iron deficiency anemia (21,25) , especially the sTfR-SF (25) , it is interesting to note that there was higher concentration in both conventional and infliximab groups compared to remission and control group, at baseline, 2 and 6 months after treatment. One study with children (25) showed that sTfR and sTfR/log ferritin were significantly higher in the IBD group than the control group.…”

“…In order to assess anemia in IBD, the most useful body iron status indicators are transferrin saturation (8)(9)(10) , soluble transferrin receptor (sTfR) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) , serum iron (11,12,17,(22)(23)(24) , soluble transferrin receptor/ ferritin ratio (sTfR-SF) (12,14,16,17,25) and transferrin (17,26,27) ; while erythrocyte sedimentation rate (ESR) (11,17,22,23,26,28) , interleukin-6 (IL-6) (22,24,26) , ferritin (11,12,16,17,(23)(24)(25)(26)(27)(28)(29)(30) , albumin (24) an...…”

Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004

“…Bei aktiver Entzündung und Ferritin-Werten zwischen 30-100 μg/l liegt häufig eine Kombination aus einer ACD und einem Eisenmangel vor [563]. Eine aktuelle französische Studie an 129 Crohn-Patient*innen zeigte, dass sich weder für Ferritin noch für die Transferrinsättigung Grenzwerte finden lassen, die mit hinreichender Genauigkeit die Feststellung einer Eisenmangelanämie erlauben [566]. Insofern sollte zur Feststellung eines Eisenmangels das Verhältnis von löslichem Transferrin-Rezeptor (sTR) und Serum-Ferritin bestimmt werden (sTR/log Ferritin-Index) [563,567,568].…”