Can Red Cell Distribution Width Be Used as a Marker of Crohn's Disease Activity?

INTRODUCTION: Recently, it has been suggested an association between red cell distribution width (RDW) and Crohn's disease activity index (CDAI), but its use is not yet performed in daily clinical practice. OBJECTIVES: To determine whether RDW can be used as a marker of Crohn's disease (CD) activity. METHODS: This was a cross-sectional study including patients with CD, observed consecutively in an outpatient setting between January 1st and September 30th 2013. Blood cell indices, erythrocyte sedimentation rate (ESR), and C-reactive protein were measured. CD activity was determined by CDAI (active disease if CDAI ≥ 150). Associations were analyzed using logistic regression (SPSS version 20). RESULTS: 119 patients (56% female) were included in the study with a mean age of 47 years (SD 15.2). Twenty patients (17%) had active disease. The median RDW was 14.0 (13-15). There was an association between RDW and disease activity (p = 0.044). After adjustment for age and gender, this association remained consistent (OR 1.20, 95% CI 1.03-1.39, p = 0.016). It was also found that the association between RDW and disease activity was independent of hemoglobin and ESR (OR 1.36, 95% CI 1.08-1.72, p = 0.01) and of biologic therapy (OR 1.19, 95% CI 1.03-1.37, p = 0.017). A RDW cutoff of 16% had a specificity and negative predictive value for CDAI ≥ 150 of 88% and 86%, respectively. CONCLUSION: In this study, RDW proved to be an independent and relatively specific marker of CD activity. These results may contribute to the implementation of this simple parameter, in clinical practice, aiming to help therapeutic decisions.

INTRODUÇÃO: Recentemente, tem vindo a ser sugerida uma associação entre o valor de RDW e a atividade da doença de Crohn (DC), mas a sua utilização não está ainda implementada na prática clínica diária. OBJETIVOS: Determinar se o RDW pode ser utilizado como marcador de atividade da DC. MÉTODOS: Estudo transversal, em doentes com DC, observados consecutivamente em consulta de Doença Inflamatória Intestinal, entre 1 de janeiro e 30 de setembro de 2013. Analisaram-se índices do hemograma, proteína C reativa e velocidade de sedimentação. A gravidade da doença foi avaliada pelo Crohn's disease activity index (doença ativa se CDAI≥150). As associações foram estudadas usando a regressão logística (SPSS Statistics V20). RESULTADOS: Incluídos 119 doentes (56% do sexo feminino), com idade média de 47 anos (DP 15,2 anos). Vinte doentes (17%) tinham doença ativa. O valor do RDW mediano foi 14,0% (13-15). Verificou-se uma associação entre RDW e atividade da doença (p = 0,044). Após ajuste para a idade e o sexo, esta associação manteve-se consistente (OR 1,20; 95% CI 1,03-1,39; p = 0,016). Verificou-se ainda que a associação do valor do RDW com a atividade da doença foi independente do valor da hemoglobina e da velocidade de sedimentação (OR 1,36; 95% CI 1,08-1,72; p = 0,01) e da terapêutica biológica (OR 1,19; 95% CI 1,03-1,37; p = 0,017). Para um valor de corte de RDW de 16%, a especificidade e o valor preditivo negativo de CDAI≥ 150 foram de 88% e 86%, respetivamente. CONCLUSÃO: Neste estudo, o valor do RDW demonstrou ser um marcador independente e relativamente específico da atividade da doença de Crohn. Estes resultados poderão contribuir para a aplicação deste parâmetro simples, na prática clinica diária, visando auxiliar decisões terapêuticas.

Clinical and genetic factors predicting response to therapy in patients with Crohn's disease.

AIM: To identify clinical and/or genetic predictors of response to several therapies in Crohn's disease (CD) patients. METHODS: We included 242 patients with CD (133 females) aged (mean ± standard deviation) 39 ± 12 years and a disease duration of 12 ± 8 years. The single-nucleotide polymorphisms (SNPs) studied were ABCB1 C3435T and G2677T/A, IL23R G1142A, C2370A, and G9T, CASP9 C93T, Fas G670A and LgC844T, and ATG16L1 A898G. Genotyping was performed with real-time PCR with Taqman probes. RESULTS: Older patients responded better to 5-aminosalicylic acid (5-ASA) and to azathioprine (OR 1.07, p = 0.003 and OR 1.03, p = 0.01, respectively) while younger ones responded better to biologicals (OR 0.95, p = 0.06). Previous surgery negatively influenced response to 5-ASA compounds (OR 0.25, p = 0.05), but favoured response to azathioprine (OR 2.1, p = 0.04). In respect to genetic predictors, we observed that heterozygotes for ATGL16L1 SNP had a significantly higher chance of responding to corticosteroids (OR 2.51, p = 0.04), while homozygotes for Casp9 C93T SNP had a lower chance of responding both to corticosteroids and to azathioprine (OR 0.23, p = 0.03 and OR 0.08, p = 0.02,). TT carriers of ABCB1 C3435T SNP had a higher chance of responding to azathioprine (OR 2.38, p = 0.01), while carriers of ABCB1 G2677T/A SNP, as well as responding better to azathioprine (OR 1.89, p = 0.07), had a lower chance of responding to biologicals (OR 0.31, p = 0.07), which became significant after adjusting for gender (OR 0.75, p = 0.005). CONCLUSIONS: In the present study, we were able to identify a number of clinical and genetic predictors of response to several therapies which may become of potential utility in clinical practice. These are preliminary results that need to be replicated in future pharmacogenomic studies.

[Non-traumatic spontaneous intramural hematoma of the small bowel: an infrequent complication of anticoagulation therapy]. / Hematoma intramural espontáneo no traumático del intestino delgado: una complicación poco habitual de los anticoagulantes.

Intramural hematoma of the small bowel is an infrequent complication of the use of oral anticoagulants. Diagnosis can only be performed when these symptoms are associated with a history of oral anticoagulant use and radiological tests. We report the case of a patient admitted for epigastric pain associated with oral anticoagulation therapy with warfarin and a 48-h history of retention vomiting. Ultrasound and abdominal computed tomography scans revealed a jejunal loop with diffuse parietal thickening, suggesting an intramural hematoma. Conservative therapy was provided with symptomatic regression on the second day and reabsorption of the jejunal intramural hematoma. Anticoagulation therapy was reintroduced with no recurrences.