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Explorative study on the value of hepcidin in predicting iron non-responsiveness in paediatric inflammatory bowel
Nanja Bevers1,2,3, Arta Aliu4,5, Ashkan Rezazadeh Ardabili4,5
1Department of Paediatrics, Zuyderland Medical Center, Sittard-Geleen, the Netherlands. nanja.bevers@mumc.nl.
Insights
Predicting iron treatment response in anaemic children with inflammatory bowel disease (IBD) is crucial. Baseline hepcidin levels, alongside haemoglobin, effectively identify non-responders to iron therapy early.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Inflammatory Bowel Disease Research
Background:
- Iron deficiency anemia is common in pediatric inflammatory bowel disease (IBD).
- Many anemic children with IBD do not achieve normal hemoglobin levels with standard iron therapy.
- Novel iron markers are needed to predict treatment response.
Purpose of the Study:
- To evaluate the added value of hepcidin and soluble transferrin receptor (sTfR) compared to traditional iron markers (ferritin, transferrin saturation [TSAT]).
- To determine the optimal strategy for predicting non-responsiveness to iron supplementation in anemic pediatric IBD patients.
Main Methods:
- Secondary analysis of prospectively collected data from anemic children (Hb Z-score < -2.0) with IBD.
- Measurement of iron markers at baseline and one month after iron therapy initiation.
- Logistic regression used to build multi-biomarker prognostic models; non-responsiveness defined as <1 Hb Z-score increase in one month.
Main Results:
- 40% (16/40) of anemic pediatric IBD patients were non-responsive to iron therapy after one month.
- Baseline hemoglobin (Hb) Z-score and hepcidin Z-score showed the highest predictive ability (AUROC 0.80).
- Hepcidin demonstrated higher sensitivity (69%) and specificity (92%) in predicting iron non-response compared to traditional markers.
Conclusions:
- A diagnostic strategy using baseline Hb Z-score and hepcidin Z-score reliably identifies anemic children with IBD who will not respond to iron therapy.
- Early identification of non-response to iron therapy is essential in pediatric IBD.
- Hepcidin cut-off values can facilitate timely and appropriate iron treatment adjustments.
Background:
In a considerable proportion of anaemic children with inflammatory bowel disease (IBD), haemoglobin (Hb) does not normalise after iron therapy. We evaluated the added value of novel iron markers (hepcidin and soluble transferrin receptor [sTfR]) as compared to traditional iron markers (ferritin and transferrin saturation [TSAT]) to determine the best strategy for the prediction of non-responsiveness to iron suppletion.
Methods:
In this secondary analysis of prospectively collected data, we measured iron markers in anaemic children (Hb Z-score < -2.0) with IBD at baseline and one month after the initiation of iron therapy. Non-responsiveness was defined as an increase in Hb Z-score of less than 1 within a month. Logistic regression analysis was used to construct multi-biomarker prognostic models.
Results:
Of 40 anaemic paediatric IBD patients, sixteen (40%) were non-responsive to iron therapy after one month. Hb Z-score and hepcidin Z-score had the highest predictive ability (area under the ROC curve [AUROC] 0.80) providing sensitivity of 69% and specificity 92%. In a post-hoc analysis we defined hepcidin cut-off values to predict iron non-responsiveness.
Conclusion:
A diagnostic strategy that involves baseline Hb Z-score and hepcidin Z-score in anaemic children with IBD reliably identifies those who will not respond to iron therapy.
Impact:
Non-response to oral and intravenous iron suppletion therapy is high in paediatric IBD and should be identified early. Prediction models using baseline hepcidin demonstrated higher sensitivity and specificity to predict iron non-response compared to models using baseline traditional iron indicators (ferritin and transferrin saturation). In a post hoc analysis, we defined cut-off values for hepcidin to facilitate the correct timing of iron treatment in young anaemic patients with chronic inflammatory bowel disease.
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