Abstract

Detectable Laboratory Abnormality Is Present up to 12 Months Prior to Diagnosis in Patients with Crohn's Disease

Irwin JR1,2,3,4, Ferguson E5,6, Simms LA5, Hanigan K5, Doecke JD7, Langguth D8, Arnott A8, Radford-Smith G5,9,6. Dig Dis Sci. 2018 Nov 26. doi: 10.1007/s10620-018-5357-0. [Epub ahead of print]
 
     

Author information

1 Inflammatory Bowel Diseases Research Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia. James.Irwin@midcentraldhb.govt.nz.

2 Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia. James.Irwin@midcentraldhb.govt.nz.

3 School of Medicine, The University of Queensland, Brisbane, Australia. James.Irwin@midcentraldhb.govt.nz.

4 Palmerston North Hospital, 50 Ruahine Street, Palmerston North, 4442, New Zealand. James.Irwin@midcentraldhb.govt.nz.

5 Inflammatory Bowel Diseases Research Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.

6 School of Medicine, The University of Queensland, Brisbane, Australia.

7 CSIRO Health and Biosecurity/Australian E-Health Research Centre, Brisbane, Australia.

8 Department of Immunology, Sullivan and Nicolaides Pathology, Brisbane, Australia.

9 Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Australia.

Abstract

BACKGROUND AND AIMS: Patients with inflammatory bowel disease (IBD) often have subjective symptoms for months or years prior to their diagnosis. Blood tests taken prior to diagnosis may provide objective evidence of duration of pre-diagnosis disease. We aim to describe the pre-diagnosis laboratory pattern of patients with IBD.

METHODS: A total of 838 patients diagnosed with IBD between 01/01/1996 and 01/03/2014, with pre-diagnosis laboratory testing available, contributed data for analysis. C-reactive protein, erythrocyte sedimentation rate, hemoglobin level, mean cell volume (MCV) platelet count, white blood cell count, neutrophil count, albumin level, ferritin level, serum iron level, alanine transaminase level, and fecal calprotectin were examined in the 24 months leading up to diagnosis and compared to baseline data taken between 24 and 36 months prior to diagnosis.

RESULTS: For patients with Crohn's disease, a significant drop in serum albumin and MCV levels and a significant rise in platelet count were observed between 115 and 385 days prior to diagnosis (p < 0.01, two-tailed t test). For patients with ulcerative colitis, a significant change in albumin level, MCV, hemoglobin level, platelet count, and serum iron level was observed at diagnosis (p < 0.01, two-tailed t test) but was not detectable before.

CONCLUSIONS: These data provide objective evidence of duration of delay between disease onset and diagnosis in a cohort of patients with IBD. Expediting diagnostic testing in patients presenting with symptoms consistent with IBD, who also have abnormal laboratory results, may reduce diagnostic delay, speed access to therapy, and improve clinical outcomes.

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