Background. Celiac disease (CD) is significantly underdiagnosed, despite significant efforts made in the last decades to increase its diagnostic rate. This has lead to a high need for developing new diagnostic strategies. Our aim was to evaluate the diagnostic performance of two routine hematologic indices for CD. Methods. In a prospective observational study, 34 newly diagnosed CD patients, 34 age-sex matched controls with irritable bowel syndrome (IBS) and 16 treated CD patients were assessed regarding the differences in mean lymphocyte count (LY), red blood cell distribution width (RDW) and their ratio (RDW/LY). Results. Elevated RDW (>14) and lymphopenia (<1.5 x 10e9/L) were more frequently seen in newly diagnosed CD patients compared to IBS control group and treated CD patients. Newly diagnosed CD patients had significantly higher mean values of RDW/LY - 10.09, compared to 7.72 in the CD-treated group and 6.79 in IBS controls (p<0.01). Subgroup analysis revealed that RDW/LY was higher in patients with destructive histology (Marsh≥3a), 10.54 vs. 7.99. For a value over 7, RDW/LY had a sensitivity of 88.24% (95% CI 72.55-96.70%) and AUROC of 0.785 (95% CI 0.683- 0.887). Conclusions. RDW/LY ratio is a widely available tool which could be used routinely in clinical practice for CD screening.
1. Urwin H, Wright D, Twigg M, McGough N. Early recognition of coeliac disease through community pharmacies: a proof of concept study. Int J Clin Pharm. 2016; 38(5):1294-300. DOI: 10.1007/s11096-016-0368-4
2. West J, Fleming KM, Tata LJ, Card TR, Crooks CJ. Incidence and Prevalence of Celiac Disease and Dermatitis Herpetiformis in the UK Over Two Decades: Population- Based Study. The American Journal of Gastroenterology. 2014;109(5):757. DOI: 10.1038/ajg.2014.55
3. Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA; American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of coeliac disease. Am J Gastroenterol. 2013;108:656-76. DOI: 10.1038/ajg.2013.79
4. Rodríguez Almagro J, Hernández Martínez A, Lucendo AJ, Casellas F, Solano Ruiz MC, Siles González J. Health-related quality of life and determinant factors in celiac disease. A population-based analysis of adult patients in Spain. Rev Esp Enferm Dig. 2016;108(4):181-9. DOI: 10.17235/reed.2016.4094/2015
6. Baydoun A, Maakaron JE, Halawi H, Abou Rajal J, Taher AT. Hematological manifestations of celiac disease. cand J Gastroenterol. 2012; 47: 1401-11. DOI: 10.3109/00365521.2012.706828
7. Bai JC, Fried M, Corrazza GR, Schuppan D, Farthing M, Catassi C, et al. World Gastroenterology Organisation global guidelines on coeliac disease. J Clin Gastroenterol. 2013;47:121-6. DOI: 10.1097/ MCG.0b013e31827a6f83
8. Ludvigsson JF, Bai JC, Biagi F, Card TR, Ciacci C, Ciclitira PJ, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014;63:1210-28. DOI: 10.1136/gutjnl-2013-306578
9. Sategna Guidetti CS, Scaglione N, Martini S. Red cell distribution width as a marker of celiac disease: a prospective study. Eur J Gastroenterol Hepatol 2002;14:177-81. DOI: 10.1097/00042737-200202000-00012
10. Brusco G, Stefani MD, Corazza GR. Increased red cell distribution width and coeliac disease. Digest Liver Dis 2000; 32:128-130. DOI: 10.1016/S1590- 8658(00)80399-0
11. Balaban DV, Popp A, Lungu AM, Costache RS, Anca IA, Jinga M. Ratio of spleen diameter to red blood cell distribution width: a novel indicator for celiac disease. Medicine (Baltimore). 2015;94(15):e726. DOI: 10.1097/MD.0000000000000726
12. Di Sabatino A, D’Alò S, Millimaggi D, Ciccocioppo R, Parroni R, Sciarra G, et al. Apoptosis and peripheral blood lymphocyte depletion in coeliac disease. Immunology. 2001; 103(4):435-40. DOI: 10.1046/j.1365-2567.2001.01245.x
13. Brandt L, Stenstam M. Letter: Subnormal lymphocyte- counts in adult coeliac disease. Lancet. 1975;1(7913):978-9. DOI: 10.1016/S0140- 6736(75)92041-3
15. Di Sabatino A, Bertrandi E, Casadei Maldini M, Pennese F, Proietti F, Corazza GR. Phenotyping of pe ripheral blood lymphocytes in adult coeliac disease. Immunology. 1998;95:572-6. DOI: 10.1046/j.1365-2567.1998.00651.x
16. Douglas AP, Weetman AP, Haggith JW. The distribution and enteric loss of 51Cr-labelled lymphocytes in normal subjects and in patients with coeliac disease and other disorders of the small intestine. Digestion. 1976, 14: 29-43. DOI: 10.1159/000197797
17. Muller C, Wolf H, Gottlicher J, Zielinski CC, Eibl MM. Cellular immunodeficiency in protein-losing enteropathy. Predominant reduction of CD3+ and CD4+ lymphocytes. Dig Dis Sci 1991;36:116-22. DOI: 10.1007/ BF01300099
19. O’Donoghue DP, Lancaster-Smith M, Laviniere P, Kumar PJ. T cell depletion in untreated adult coeliac disease. Gut 1976; 17:328-331. DOI: 10.1136/ gut.17.5.328
20. Tuire I, Marja-Leena L, Teea S, Katri H, Jukka P, Paivi S, Heini H, et al. Persistent duodenal intraepithelial lymphocytosis despite a long-term strict gluten-free diet in celiac disease. Am J Gastroenterol. 2012;107:1563-9. DOI: 10.1038/ajg.2012.220
21. Lanzini A, Lanzarotto F, Villanacci V, Mora A, Bertolazzi S, Turini D, et al. Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Aliment Pharmacol Ther. 2009;29:1299-308. DOI: 10.1111/j.1365-2036.2009.03992.x
22. Danese E, Lippi G, Montagnana M. Red blood cell distribution width and cardiovascular diseases. J Thorac Dis 2015; 7:E402-11.
23. Montagnana M, Danese E. Red cell distribution width and cancer. Ann Transl Med. 2016; 4(20):399. DOI: 10.21037/atm.2016.10.50
24. Guglielmi V, Manchisi M, Pellegrini V, Tutino M, Guerra V. RDW: new screening test for coeliac disease? Minerva Med. 2002; 93(5):419-421.
25. Martha O, Porav-Hodade D, Bălan D, Tătaru OS, Sin A, Chibelean CB, et al. Easily Available Blood Test Neutrophil- To-Lymphocyte Ratio Predicts Progression in High-Risk Non-Muscle Invasive Bladder Cancer. Rev Romana Med Lab. 2017; 25(2):181-9. DOI: 10.1515/rrlm-2017-0016
26. Hadadi L, Sus I, Lakatos EK, Serban RC, Scridon A, Demjen Z, et al. Platelet indices and platelet-to-lymphocyte ratio predict coronary chronic total occlusion in patients with acute ST-elevation myocardial infarction. Rev Romana Med Lab. 2015;23(4):407-14. DOI: 10.1515/rrlm-2015-0041
27. Sarikaya M, Dogan Z, Ergul B, Filik L. Neutrophil- to-lymphocyte ratio as a sensitive marker in diagnosis of celiac disease. Ann Gastroenterol. 2014;27(4):431-2.
28. Sarikaya M, Dogan Z, Ergul B, Filik L. Platelet-to-lymphocyte ratio for early diagnosis of celiac disease. Indian J Gastroenterol. 2015; 34(2):182-3. DOI: 10.1007/ s12664-014-0493-8