Zinc Protoporphyrin Is a Reliable Marker of Functional Iron Deficiency in Patients with Inflammatory Bowel Disease
Iron deficiency (ID) is a common manifestation of inflammatory bowel disease (IBD), arising primarily due to chronic inflammation and/or blood loss. There is no gold standard for ID diagnosis, which is often complicated by concomitant inflammation. Zinc protoporphyrin (ZnPP) correlates with paramete...
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doaj-f2d1ba0118654277b771e30c09d9d7652021-02-22T00:04:10ZengMDPI AGDiagnostics2075-44182021-02-011136636610.3390/diagnostics11020366Zinc Protoporphyrin Is a Reliable Marker of Functional Iron Deficiency in Patients with Inflammatory Bowel DiseaseEleni Leventi0Aysegül Aksan1Carl Thomas Nebe2Jürgen Stein3Karima Farrag4Klinik für Gastroenterologie, Diabetologie und Infektiologie, Klinikum Hanau, 63450 Hanau, GermanyInterdisziplinäres Crohn Colitis Centrum Rhein-Main, 60594 Frankfurt am Main, GermanyFacharztpraxis für Laboratoriumsmedizin, 68161 Mannheim, GermanyInterdisziplinäres Crohn Colitis Centrum Rhein-Main, 60594 Frankfurt am Main, GermanyInterdisziplinäres Crohn Colitis Centrum Rhein-Main, 60594 Frankfurt am Main, GermanyIron deficiency (ID) is a common manifestation of inflammatory bowel disease (IBD), arising primarily due to chronic inflammation and/or blood loss. There is no gold standard for ID diagnosis, which is often complicated by concomitant inflammation. Zinc protoporphyrin (ZnPP) correlates with parameters of iron homeostasis and has been identified as a promising marker for ID, irrespective of inflammation. We investigated the diagnostic performance of ZnPP in ID, iron deficiency anemia, anemia of chronic disease and mixed anemia in a cross-sectional study in 130 patients with IBD. Different parameters were compared by receiver operator characteristic (ROC) analysis as detectors of iron-restricted erythropoiesis (IRE). IRE was detected in 91 patients (70.0%); fifty-nine (64.8%) had absolute ID and 23 (25.4%) functional ID. When inflammation was present, ZnPP was a more reliable sole biomarker of IRE than MCV, transferrin saturation (TSAT) or ferritin (AUC; 0.855 vs. 0.763, 0.834% and 0.772, respectively). The specificity of TSAT was significantly lower than ZnPP when inflammation was present (38% vs. 71%, respectively). We conclude that ZnPP is a reliable biomarker of functional ID in patients with IBD and more dependable than ferritin or TSAT, which are influenced by chronic inflammation. We propose that ZnPP may also have utility in patients with other chronic diseases.https://www.mdpi.com/2075-4418/11/2/366anemiainflammatory bowel diseaseiron deficiencyzinc protoporphyrin |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eleni Leventi Aysegül Aksan Carl Thomas Nebe Jürgen Stein Karima Farrag |
spellingShingle |
Eleni Leventi Aysegül Aksan Carl Thomas Nebe Jürgen Stein Karima Farrag Zinc Protoporphyrin Is a Reliable Marker of Functional Iron Deficiency in Patients with Inflammatory Bowel Disease Diagnostics anemia inflammatory bowel disease iron deficiency zinc protoporphyrin |
author_facet |
Eleni Leventi Aysegül Aksan Carl Thomas Nebe Jürgen Stein Karima Farrag |
author_sort |
Eleni Leventi |
title |
Zinc Protoporphyrin Is a Reliable Marker of Functional Iron Deficiency in Patients with Inflammatory Bowel Disease |
title_short |
Zinc Protoporphyrin Is a Reliable Marker of Functional Iron Deficiency in Patients with Inflammatory Bowel Disease |
title_full |
Zinc Protoporphyrin Is a Reliable Marker of Functional Iron Deficiency in Patients with Inflammatory Bowel Disease |
title_fullStr |
Zinc Protoporphyrin Is a Reliable Marker of Functional Iron Deficiency in Patients with Inflammatory Bowel Disease |
title_full_unstemmed |
Zinc Protoporphyrin Is a Reliable Marker of Functional Iron Deficiency in Patients with Inflammatory Bowel Disease |
title_sort |
zinc protoporphyrin is a reliable marker of functional iron deficiency in patients with inflammatory bowel disease |
publisher |
MDPI AG |
series |
Diagnostics |
issn |
2075-4418 |
publishDate |
2021-02-01 |
description |
Iron deficiency (ID) is a common manifestation of inflammatory bowel disease (IBD), arising primarily due to chronic inflammation and/or blood loss. There is no gold standard for ID diagnosis, which is often complicated by concomitant inflammation. Zinc protoporphyrin (ZnPP) correlates with parameters of iron homeostasis and has been identified as a promising marker for ID, irrespective of inflammation. We investigated the diagnostic performance of ZnPP in ID, iron deficiency anemia, anemia of chronic disease and mixed anemia in a cross-sectional study in 130 patients with IBD. Different parameters were compared by receiver operator characteristic (ROC) analysis as detectors of iron-restricted erythropoiesis (IRE). IRE was detected in 91 patients (70.0%); fifty-nine (64.8%) had absolute ID and 23 (25.4%) functional ID. When inflammation was present, ZnPP was a more reliable sole biomarker of IRE than MCV, transferrin saturation (TSAT) or ferritin (AUC; 0.855 vs. 0.763, 0.834% and 0.772, respectively). The specificity of TSAT was significantly lower than ZnPP when inflammation was present (38% vs. 71%, respectively). We conclude that ZnPP is a reliable biomarker of functional ID in patients with IBD and more dependable than ferritin or TSAT, which are influenced by chronic inflammation. We propose that ZnPP may also have utility in patients with other chronic diseases. |
topic |
anemia inflammatory bowel disease iron deficiency zinc protoporphyrin |
url |
https://www.mdpi.com/2075-4418/11/2/366 |
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