Serum Hepcidin and Iron Absorption in Paediatric Inflammatory Bowel Disease

Abstract

Background and aims: We sought to correlate hepcidin levels in inflammatory bowel disease [IBD] children with disease activity, inflammatory markers, and iron load test [ILT] and to compare IBD patients with coeliac and healthy patients.

Methods: Between December 2012 and June 2013, 145 subjects [50 IBD patients, 45 coeliac patients and 50 healthy controls] were included in the study. All patients underwent the following examinations: blood count, iron status, erythropoiesis parameters, serum hepcidin, C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]. In order to evaluate the efficacy of iron absorption, ILT was performed in IBD patients. Disease activity indexes and IBD duration, localisation, and therapy were also evaluated, and a faecal sample for calprotectin collected.

Results: Serum hepcidin was significantly higher in IBD patients with active disease compared with both coeliac and healthy patients [p = 0.005, p = 0.003 respectively]. In a multivariate logistic regression model, having a Paediatric Crohn's Disease Activity Index [PCDAI] / Paediatric Ulcerative Colitis Activity Index [PUCAI] ≥ 30 resulted in the only variable independently associated with a positive serum hepcidin (odds ratio [OR] = 6.87; 95% confidence interval [CI] 1.4-33, p = 0.01]]. Patients with iron malabsorption [IM] showed higher values of ESR, CRP, and hepcidin [p = 0.02, p = 0.001, and p = 0.06, respectively]. Eight out of 12 [66.7%] children with IM showed an active disease compared with 6/31 [19.3%] children with normal ILT [p = 0.01]. Hepcidin levels correlated negatively with ILT [r = -0.451, p = 0.002], and positively with ferritin and CRP [r = 0.442, p = 0.0001; r = 0.243, p = 0.009, respectively]

Conclusions: Our study demonstrates that serum hepcidin is increased in IBD children with active disease and it is responsible for IM.

Keywords: Hepcidin; IBD; iron absorption.

Figure 1.

Correlations between log-transformed serum hepcidin and Δ[Fe]2hr [r = -0.451, p = 0.002] in inflammatory bowel disease [IBD patients]. [A] Correlations between log-transformed serum hepcidin and log-transformed ferritin [r = 0.442, p = 0.0 001]. [B] C-reactive protein [CRP] [r = 0.243, p = 0.009] and [C] transferrin [r = -0.249, p = 0.005], [D] in all the enrolled patients.

Figure 2.

Correlations between Δ[Fe]2hr and log-transformed ferritin [r = -0.588, p = 0.0 001]. [A] C-reactive protein [CRP] [r = -0.585, p = 0.0 001] and [B] transferrin [r = 0.613, p = 0.0 001], [C] in inflammatory bowel disease [IBD] patients.